An Epidemic of Fear (Anti-Vaccination Bullshit)

[K. A. Pital]

Yeah, but I thought cowpox vaccine was safe, as opposed to variolation. Serves me right for not checking.

[Broomstick]

It's safer, but still a high complication vaccine. It's not like I'd expect most people these days to know that, what with smallpox being extinct in the wild and the vaccine no longer routine. Thanks goodness for that.

I hear rinderpest is also gone now, last confirmed case in 2001. That was a cattle disease, but there's a theory that human measles may have evolved from it.

We should be able to eliminate measles, polio, and a few others IF people weren't so stupid about vaccination and IF someone was willing to fund the project.

[PeZook]

The issue with smallpox vaccination was sidestepped neatly in Poland by administering it in two phases: first, schoolchildren were jabbed with a miniscule dose of the virus. The reaction to the jab would indicate if complications were likely or not.

Then those children determined suitable received the full vaccine, while the rest benefitted from herd immunity.

I could only imagine it was the same everywhere else, as it's a simple and elegant solution.

[Broomstick]

In the US it was nigh-impossible to get a medical exemption to the smallpox vaccine - even though I was a significant risk of complications, including fatal ones, due to my skin condition at the time I still got the vaccine. In that case, the society traded off a certain number of deaths for vaccinating nearly the entire population. They stopped making the vaccine routine in the 1970's, when smallpox was extinct in the Western Hemisphere, when the vaccine was killing considerably more people than the disease was, though the government kept stocks of the vaccine on hand just in case some traveler from abroad brought it back by accident.

Some people were exempted, I'm sure, or simply avoided the vaccine. But back in those days there were a lot of international borders you couldn't cross without proof of such vaccination (as simple as displaying the distinctive scar) so it might potentially inconvenience someone. Again, not so much in North America, probably had more effect other places.

In case anyone is wondering what the smallpox vaccine scar looks like (as they are now exceedingly rare in those under 40) here's a photo:

Looks like this person was vaccinated more than once, or perhaps the initial vaccination pustule spread (which sometimes happened, it being a live virus and all), with the round scar on the left being the classic form. If there was an outbreak somewhere you would be physically prevented from leaving the area unless you could display a scar such as this. In some times and places this scar was more important for border crossing than a passport or visa.

[PeZook]

Schoolchildren in Poland were still being vaccinated against smallpox as late as the mid-1990s.

[Broomstick]

I was aware it was being done in the 1980's, as I had Polish co-workers who needed to be re-vaccinated to go back for visits to Poland, but I wasn't aware it extended into the 1990's. The US stopped the program in the 1970's, as I said, but then smallpox was eradicated earlier on this half the planet.

The last outbreak ever that I'm aware of was due to a laboratory mishap in England in 1978, resulting in two death (three if you count the researcher who committed suicide when he learned that it was he was the origin of the outbreak). Since then, with the only two known stocks of the virus in the US and (originally) USSR (I think it's Russian owned now) there has always been some concern with its use in bioterrorism or warfare. Presumably, the US knows what's was in the Soviet stock up to a certain point because of a Soviet defector (Ken Alibeck? Am I remembering the name right?) but fears of what the US might be up to may well have kept the Eastern Block vaccinating for quite some time.

Now I think there's more concern with possible diversion of the virus stocks into terrorist hands, but how likely that is, I can't say. I think it's unlikely, but the possibility is why plenty of governments maintain the ability to vaccinate against a disease that is supposedly extinct. If someone is stupid enough to ever revive that disease the results will be extremely ugly.

[SpaceMarine93]

Sometimes, I try to resist an urge to declare out loud that what the government should do to ensure vaccination is to deny a town with many people who complain about vaccination the vaccines for an entire generation and watch apathetically their arrogant and distrustful hearts twist in anguish while their loved ones and children die in all sorts of horrifying diseases that are curable with vaccines, and FILMING THE ENTIRE PROCESS AND PLACE IT ON YOUTUBE SO THAT THEY CAN SHOW THOSE LOW DOWN MISERABLE IGNORANT F***FACES THE CONSEQUENCES IF THEY DO NOT TRUST SCIENCE AND CONTINUE THEIR ARROGANT, SELF-RIGHTEOUS CAMPAIGN OF DESTROYING PEOPLES' HEALTH AND LIVES JUST BECAUSE OF THEIR LITTLE SELFISH PARANOIA AND GREIVENCES ABOUT VACCINES!!!

F*** THOSE B****ES!!!

[PeZook]

Looks like you did not resist that urge after all. This thread is for constructive discussion of vaccination measures, statistics, information on preventable outbreaks etc.

In short, quality discussion, not Internet Tough Guy bullshit.

[Broomstick]

And on that happy note, let's return to an earlier bit in this thread:

As time goes by I think public health is about 75% battling cultural issues (which would include both lack of education and persistent rumors) and 20% making sure access is reasonably easy and only about 5% actual medicine.

So, how would you approach this?

In other words, cultural barriers to vaccination.

Because we're dealing with people, it's messy. It also requires highly skilled and trained people to put themselves in the intellectual and emotional shoes of others, which is difficult. While modern doctors and, to a somewhat lesser extent, other medical personnel are giving years of training it's rare they have any training cross-cultural relations.

So, the first step is to realize that, not only does the person in front of you not have all those years of training, there's no way you're going to be able to give them that knowledge. Step two is to take a deep breath and remind yourself that "ignorant" does not equal "stupid". (By the way - this goes double for educated internet tough guys who lack any skills or experience with dealing with the general public whatsoever.) Any medic worth his or her salt is going to have questions about a new medical thing they've not heard of before, or know little about, where the stumbling block comes is that to modern medics vaccination is so damn simple they've lost sight of the fact that, to many others, they're magic.

In fact, if you're dealing with a tribe just about stone age tech, there's no way you'll convince them it's NOT magic. In that context go ahead and call it magic. If the only way they can relate to it is telling them it's a defensive charm against the bad spirits that cause the sickness go ahead and do it. And if their witch doctor/shaman/whatever wants to sprinkle them with magic dust, shake rattles, or whatever in the meanwhile go ahead and let them do it. It's no more silly a ritual than the cookie I used to get at the doctor's for being a "good girl" when getting a jab when I was a toddler, or lining kids up at a health fair for their shots. It's just a ritual, and if allowing the tribe to ritualize vaccination in their own cultural context makes vaccination more likely to occur it is a good thing.

But in the industrialized world that's not what we're facing, is it?

Let's take another case - the Amish. The Amish don't believe in insurance, lightning rods, or vaccination. It conflicts with their religious views, and they aren't giving them up. Historically, they've been a group that would rather die than give up their beliefs, which is why they're more or less extinct in Europe. They're stubborn. How do we deal with that?

Well, funny thing is, once they've been exposed to a disease they'll happily take treatment. For a rather extreme example, there's no way they'd ever get a prophylactic rabies vaccine but if they're bitten by a rabid dog they'll happily take the vaccine as treatment. So, wherever possible, express it as treatment if you can do so without lying to them. In the case of smallpox, there was some value in vaccinating someone exposed to the disease before symptoms showed, so that's a case where you might get cooperation during an outbreak.

One other thing about the Amish, not only do they tend to live in somewhat isolated communities, they are also very amenable to quarantine. If there is an outbreak they are extremely cooperative about quarantining the affected, enough so that their outbreaks seldom spread outside their communities. They even have their own school system apart from the public one, so their children aren't spreading outbreaks among other children. While not ideal from a public health viewpoint, to the population at large they pose little risk. In this case, since they're already socially and physically isolated and cooperative with maintaining quarantine you might be better off going after larger threats to the greater population.

That's the allegedly well educated anti-vaxxer, the people whose unvaccinated kids go to public schools and interact with larger society, providing an excellent means of spreading contagious disease. That's the worst threat, because it's how shit gets vectored all over. They're a member of the herd that, absent a legitimate medical reason, really needs the vaccinations. And it's more difficult to find the stumbling block for them - with a primitive tribesman or Amish person just knowing they're from a particular group gives you an idea of what their concerns are likely to be, for the anti-vaxxer from the larger society it could be quite a few things.

So.... ask them. Of course, there's guarantee they'll tell you the truth, but you have to start somewhere. Once you know that, you'll have to come up with a counter-argument.

Some possible examples:

Gardasil: the problem here often seems to be that it is intended to guard against an STD, and parents either deny the child is having sex, or will have sex before marriage and gets into religious issues. Some possible tactics might include pointing that while this particular child might remain virgin until the wedding the future spouse might or might not also be a virgin, and this protects against a future spouse's past history. I don't know if mentioning that rape is a risk would backfire or not - among some Christians that might be a convincing tactic, but among certain other groups where "honor killing" is seen as a "solution" to a raped women this might be a bad idea. You might mention that in addition to cervical cancer it also guards against certain cancers of the head and neck.... but perhaps not mention that they are also linked to oral sex. In other words, de-sexualize the vaccination somewhat. If the parent is concerned the child is "too young" take that into account. Yes, I know that this is pushed as something a kid should get around 12, but getting it at 14 or 16 or 18 is preferable to not at all. I sometimes think medicine gets way too focused on when a vaccination "should" be given that it loses sight that later is better than never.

Childhood vaccines: If the concern is the non-existent autism risk it's a problem. On the other hand, if it's a concern about when, then perhaps a delay past the "window" of autism risk could be tolerated as long as there is follow up so the kid gets the shots before school age... which, for better or worse, is getting earlier and earlier it seems. If the kid is in pre-school they're at risk. If they're in daycare they're at risk. It's still better to vaccinate them a year or two "late" than not at all.

I've run into people who think that somehow vaccines weaken the immune system. In that case, you might argue that no, it's like athletic training, it gives the immune system a little exercise, which makes it stronger. Or maybe it's like a "wanted" poster - it shows the immune system what the germ looks like, so it can better recognize it and fight it better. A somewhat sloppy metaphor that gets a person to roll up their sleeve is better in this regard than a highly precise but unintelligible scientific explanation.

Adult vaccines: Honestly, modern medicine is bad at this, at least in America. I can't ever recall a doctor asking if I'm up to date on the tetanus-diphtheria vaccine, and in fact, a couple years ago I went through a lot of shit to get updated. At least in the US, medicine has concentrated so hard on immunizing children the adults have been forgotten - but an adult with whooping cough is just as contagious as a kid, and less likely to stay home. I know all too many adults who think vaccines are "kid stuff" and being adults they don't need them any more. This will become more and more an issue as we now know many vaccines do NOT grant lifetime immunity - if you get a chickpox vaccine as a kid you will need boosters as an adult, or risk getting the disease at a worse time than childhood. Do adults know that?

I think some of the anti-vaxxers got jabs as toddlers and never since, so they've forgotten that vaccines are largely non-events. Maybe if adults got shots regularly they wouldn't seem so damn scary, huh? My parents got polio vaccine after they reached adulthood, because it didn't exist when they were children, so they went through vaccination at a time they could remember and when it came time to vaccinate the kids they knew it was no big deal. (My oldest sister also got her polio vaccine "late" by today's standards, as she also pre-dated the mass immunization)

On the list of stupid reasons (IMHO) is the "I'll get a sore arm" syndrome. Yes, it's a common side effect, as is feeling less than your best. No, it's not fun. On the other hand, I always viewed that as proof I got an actual vaccine and my immune system is actually working. Maybe if people took that approach they wouldn't bitch so much about it.

One approach for flu vaccine they've been trying lately appeals to the workaholic corporate drone - flu is inconvenient. Nevermind risk of side effects, pneumonia, spreading it to the immunocompromised... these folks don't want to have to take a sick day. Sure, you may feel less than your best for a day or two but you'll be able to maintain your normal schedule, it's still better than the flu. Oddly enough, this seems to work on some people. I've known people who couldn't be bothered to get the flu shot, but when presented with this rationale - "reduce the chances you'll need to take a day off work" - they can't wait to get one. So... nothing wrong with appealing to selfish motivations, right?

Granted, none of those approaches are quite as certain as vaccinating at gun point. There is also the problem that, in a small isolated community you may only need to fight the battle to convince people once or a few times. Out in the larger population you have to wage a constant battle against the rumors that arise over and over again, the new fear-mongering and rumor that show up, the disinformation, and so on. While it's easy to focus on an ignorant religious group way out in the boondocks they aren't the threat to public health that a more typical person in the larger society is, just because of the number of contacts with strangers.

[SpaceMarine93]

Sorry, my bad. I was having a rough day

[Simon_Jester]

So, the first step is to realize that, not only does the person in front of you not have all those years of training, there's no way you're going to be able to give them that knowledge. Step two is to take a deep breath and remind yourself that "ignorant" does not equal "stupid". (By the way - this goes double for educated internet tough guys who lack any skills or experience with dealing with the general public whatsoever.)

Thank you. I'm seriously considering sigging this.

In fact, if you're dealing with a tribe just about stone age tech, there's no way you'll convince them it's NOT magic. In that context go ahead and call it magic. If the only way they can relate to it is telling them it's a defensive charm against the bad spirits that cause the sickness go ahead and do it. And if their witch doctor/shaman/whatever wants to sprinkle them with magic dust, shake rattles, or whatever in the meanwhile go ahead and let them do it. It's no more silly a ritual than the cookie I used to get at the doctor's for being a "good girl" when getting a jab when I was a toddler, or lining kids up at a health fair for their shots. It's just a ritual, and if allowing the tribe to ritualize vaccination in their own cultural context makes vaccination more likely to occur it is a good thing.

Another aspect of this is that in quite a few societies like that, magic is normal; they live in a mental frame of reference which is saturated with things that work by magic. The fact that something is magic does not mean they are opposed to it, and patiently spending half an hour trying to explain that it's not magic won't make them more inclined to trust it.

Adult vaccines: Honestly, modern medicine is bad at this, at least in America. I can't ever recall a doctor asking if I'm up to date on the tetanus-diphtheria vaccine, and in fact, a couple years ago I went through a lot of shit to get updated. At least in the US, medicine has concentrated so hard on immunizing children the adults have been forgotten - but an adult with whooping cough is just as contagious as a kid, and less likely to stay home. I know all too many adults who think vaccines are "kid stuff" and being adults they don't need them any more. This will become more and more an issue as we now know many vaccines do NOT grant lifetime immunity - if you get a chickpox vaccine as a kid you will need boosters as an adult, or risk getting the disease at a worse time than childhood. Do adults know that?

Do you know of any centralized references for which vaccines need to be updated during adulthood?

[Broomstick]

Do you know of any centralized references for which vaccines need to be updated during adulthood?

Ta-DAAAA! From the CDC: adult vaccine schedule

[Zaune]

Sometimes, I try to resist an urge to declare out loud that what the government should do to ensure vaccination is [snip]

Colourfully expressed and not especially ethical, but there's the germ of an extremely good idea here. I cannot for the life of me think of a better way to put the (thoroughly debunked) rumours about vaccines and autism into perspective than PSAs depicting the symptoms of every disease routinely vaccinated against in explicit detail, as for some bizarre reason there's a popular perception that at least some of these diseases are not a big deal; measles was the sort of illness Dennis the Menace or one of the Bash Street Kids might get laid up with for a week in the Beano, for example, and I was quite old when I found out it was something you can actually die of.

[PainRack]

In fact, if you're dealing with a tribe just about stone age tech, there's no way you'll convince them it's NOT magic. In that context go ahead and call it magic. If the only way they can relate to it is telling them it's a defensive charm against the bad spirits that cause the sickness go ahead and do it. And if their witch doctor/shaman/whatever wants to sprinkle them with magic dust, shake rattles, or whatever in the meanwhile go ahead and let them do it. It's no more silly a ritual than the cookie I used to get at the doctor's for being a "good girl" when getting a jab when I was a toddler, or lining kids up at a health fair for their shots. It's just a ritual, and if allowing the tribe to ritualize vaccination in their own cultural context makes vaccination more likely to occur it is a good thing.

Devil advocate here. But first,a nitpick.
Rituals in Healthcare has a different technical term than what you're presenting it here as. Giving a lollipop after a doctor visit, white coat and stethoscope is ritual.
This... lol, not sure what to call it.

There "are" problems with this approach of course. Namely, it simply doesn't prevent people from playing on your fears or convincing you otherwise. Theory of Reasoned action argues that health behaviours state that media play a huge role in influencing your motivation to adopt health behaviour. I could argue that a simplistic protrayl could backfire when desired results don't happen and media or other significant events happen to convince you otherwise.

So.... ask them. Of course, there's guarantee they'll tell you the truth, but you have to start somewhere. Once you know that, you'll have to come up with a counter-argument.

I would argue that reasons are just rationalisation for emotional behaviours.

If we respond purely by addressing the reasons, we actually fail to address the emotional drives that actually causing said health behaviours.
Its one of the reason why if you look at websites like http://www.cdc.gov/vaccines/vac-gen/why.htm
Emotional appeals are combined with reasons to show why they work.

Gardasil: the problem here often seems to be that it is intended to guard against an STD, and parents either deny the child is having sex, or will have sex before marriage and gets into religious issues. Some possible tactics might include pointing that while this particular child might remain virgin until the wedding the future spouse might or might not also be a virgin, and this protects against a future spouse's past history. I don't know if mentioning that rape is a risk would backfire or not - among some Christians that might be a convincing tactic, but among certain other groups where "honor killing" is seen as a "solution" to a raped women this might be a bad idea. You might mention that in addition to cervical cancer it also guards against certain cancers of the head and neck.... but perhaps not mention that they are also linked to oral sex. In other words, de-sexualize the vaccination somewhat. If the parent is concerned the child is "too young" take that into account. Yes, I know that this is pushed as something a kid should get around 12, but getting it at 14 or 16 or 18 is preferable to not at all. I sometimes think medicine gets way too focused on when a vaccination "should" be given that it loses sight that later is better than never.

For HPV, we don't know for sure but the idea now is to prevent infection. Given that the average age a person loses their virginity is 17
http://www.newstrategist.com/productdet ... plePgs.pdf
Well, I'm not from the States so perhaps you could elaborate how this vaccine is being pushed there?

Childhood vaccines: If the concern is the non-existent autism risk it's a problem. On the other hand, if it's a concern about when, then perhaps a delay past the "window" of autism risk could be tolerated as long as there is follow up so the kid gets the shots before school age... which, for better or worse, is getting earlier and earlier it seems. If the kid is in pre-school they're at risk. If they're in daycare they're at risk. It's still better to vaccinate them a year or two "late" than not at all.

Ok, I just rechecked the US schedule and it seems that the same reasons why this is a bad idea holds true.
Diptheria is mostly active and lethal for infants, which means you need to give it early. So, you can't avoid delaying that.
For Measles and mumps, its given at age one, but you need to consider that these diseases are considered lethal for kids at that age.
Hepatitis B is transmissable from a mother to her child.

The catchup schedule exists, but there's a reason why its called the catchup schedule.

edit: I would also like to add that the schedule is helpful for other reasons, as its during the first year that infants get checked up on routinely.

I've run into people who think that somehow vaccines weaken the immune system. In that case, you might argue that no, it's like athletic training, it gives the immune system a little exercise, which makes it stronger. Or maybe it's like a "wanted" poster - it shows the immune system what the germ looks like, so it can better recognize it and fight it better. A somewhat sloppy metaphor that gets a person to roll up their sleeve is better in this regard than a highly precise but unintelligible scientific explanation.

Just a quick question then. Isn't this how vaccines are protrayed?
Hell, its how I was TAUGHT.

Adult vaccines: Honestly, modern medicine is bad at this, at least in America. I can't ever recall a doctor asking if I'm up to date on the tetanus-diphtheria vaccine, and in fact, a couple years ago I went through a lot of shit to get updated. At least in the US, medicine has concentrated so hard on immunizing children the adults have been forgotten - but an adult with whooping cough is just as contagious as a kid, and less likely to stay home. I know all too many adults who think vaccines are "kid stuff" and being adults they don't need them any more. This will become more and more an issue as we now know many vaccines do NOT grant lifetime immunity - if you get a chickpox vaccine as a kid you will need boosters as an adult, or risk getting the disease at a worse time than childhood. Do adults know that?

Its America:D.
And just a correction here.
http://www.cdc.gov/vaccines/vpd-vac/var ... lt.htm#who
The CDC doesn't recommend adults get a booster either.

I think some of the anti-vaxxers got jabs as toddlers and never since, so they've forgotten that vaccines are largely non-events. Maybe if adults got shots regularly they wouldn't seem so damn scary, huh?

I can personally attest that no, it still remains as damn scary as it was the first time you get jabbed.
And given the attitudes of my colleagues, yeah.....

Come on, we handle needles all the time and there are still people amongst us who are afraid to donate blood because of said needles.

[Broomstick]

In fact, if you're dealing with a tribe just about stone age tech, there's no way you'll convince them it's NOT magic. In that context go ahead and call it magic. If the only way they can relate to it is telling them it's a defensive charm against the bad spirits that cause the sickness go ahead and do it. And if their witch doctor/shaman/whatever wants to sprinkle them with magic dust, shake rattles, or whatever in the meanwhile go ahead and let them do it. It's no more silly a ritual than the cookie I used to get at the doctor's for being a "good girl" when getting a jab when I was a toddler, or lining kids up at a health fair for their shots. It's just a ritual, and if allowing the tribe to ritualize vaccination in their own cultural context makes vaccination more likely to occur it is a good thing.

Devil advocate here. But first,a nitpick.
Rituals in Healthcare has a different technical term than what you're presenting it here as. Giving a lollipop after a doctor visit, white coat and stethoscope is ritual.
This... lol, not sure what to call it.

It's a ritual. You get some tribal healer to make sand paintings and chant over you it's a ritual. Cookie-white coat-stethoscope are ritual trappings, the costume and props you use to reassure people of your authority and role. It may not be what medicine defines it as, but we're not talking about a medical viewpoint - we're talking about people to whom modern medicine is magic. It's not a viewpoint you are familiar with, so it's hard for you to slip into. The jargon is different. That is, of course, why medical people have problems communicating with people with a magical mindset, it's alien to you. You keep wanting to make them see it your way, which is fairly typical of people, it's hard to really get inside someone else's worldview if theirs is very different from yours.

There "are" problems with this approach of course. Namely, it simply doesn't prevent people from playing on your fears or convincing you otherwise. Theory of Reasoned action argues that health behaviours state that media play a huge role in influencing your motivation to adopt health behaviour. I could argue that a simplistic protrayl could backfire when desired results don't happen and media or other significant events happen to convince you otherwise.

Of course there are problems with it, if there weren't problems with non-medical viewpoints we wouldn't have trouble getting people to vaccinate their kids. However, primitive tribesmen aren't going to get a lot of exposure to modern media, now are they? If they're used to taking the advice of the woo-woo person in the tribe and the woo-woo person won't buy into the vaccination stuff without being able to chant and make gestures or whatever the heck he or she usually does then let them do the woo-woo while you vaccinate.

I deal with people saturated by modern media later on.

So.... ask them. Of course, there's guarantee they'll tell you the truth, but you have to start somewhere. Once you know that, you'll have to come up with a counter-argument.

I would argue that reasons are just rationalisation for emotional behaviours.

If we respond purely by addressing the reasons, we actually fail to address the emotional drives that actually causing said health behaviours.
Its one of the reason why if you look at websites like http://www.cdc.gov/vaccines/vac-gen/why.htm
Emotional appeals are combined with reasons to show why they work.

I will certainly defer to the experts on that. However, we know that approach doesn't always work. I'm out of ideas, but I'd love for there to be an alternative that works.

Gardasil: the problem here often seems to be that it is intended to guard against an STD, and parents either deny the child is having sex, or will have sex before marriage and gets into religious issues. Some possible tactics might include pointing that while this particular child might remain virgin until the wedding the future spouse might or might not also be a virgin, and this protects against a future spouse's past history. I don't know if mentioning that rape is a risk would backfire or not - among some Christians that might be a convincing tactic, but among certain other groups where "honor killing" is seen as a "solution" to a raped women this might be a bad idea. You might mention that in addition to cervical cancer it also guards against certain cancers of the head and neck.... but perhaps not mention that they are also linked to oral sex. In other words, de-sexualize the vaccination somewhat. If the parent is concerned the child is "too young" take that into account. Yes, I know that this is pushed as something a kid should get around 12, but getting it at 14 or 16 or 18 is preferable to not at all. I sometimes think medicine gets way too focused on when a vaccination "should" be given that it loses sight that later is better than never.

For HPV, we don't know for sure but the idea now is to prevent infection. Given that the average age a person loses their virginity is 17
http://www.newstrategist.com/productdet ... plePgs.pdf
Well, I'm not from the States so perhaps you could elaborate how this vaccine is being pushed there?

Unfortunately, in some places it's not being pushed at all. And FAR too much emphasis on it being to immunize against an STD. Yes, yes, I know HPV is an STD but you scare the Fundies off by saying that too strongly. If they pushed it more as a cancer vaccine I think they'd get more buy in. Yes, in a rational world people would jump at the chance to prevent STD's but it's not a rational world and in the US you have to deal with religious nutbjobs.

And yes, girls lose their virginity early, in their teens, but all too often parents will not let their daughters get it for fear it will give them "ideas". The way it's sold it here it makes it sound like if you don't get it by 12 it's useless. It's not. Better a young women get it at 18 than not at all, because if she's having sex at 18 she's unlikely to suddenly stop, isn't she?

Don't get so focused on the ideal that you discard less than perfect but still workable strategies.

Childhood vaccines: If the concern is the non-existent autism risk it's a problem. On the other hand, if it's a concern about when, then perhaps a delay past the "window" of autism risk could be tolerated as long as there is follow up so the kid gets the shots before school age... which, for better or worse, is getting earlier and earlier it seems. If the kid is in pre-school they're at risk. If they're in daycare they're at risk. It's still better to vaccinate them a year or two "late" than not at all.

Ok, I just rechecked the US schedule and it seems that the same reasons why this is a bad idea holds true.
Diptheria is mostly active and lethal for infants, which means you need to give it early. So, you can't avoid delaying that.

Unless the parents flat out refuse to give it to a child that young. Yes, the child will be at risk longer than he or she should be, but better to be vaccinated late than not at all. There is no way to force a parent to present their child for vaccination in this country. You can't enter public school without them, but there are private schools and home schooling.

Obviously, vaccinating early is best. Unfortunately, that's not the real world. Seriously, if a parent tells you they will not allow their infant to be vaccinated what are you going to do? Stick the needle in the kid when they aren't looking? Well, alright, I could argue that it's in the best interests of the child, but heaven help you if that's the one kid who will have a problem. By all means, try every argument you can to convince the parents to do it early, but it may not work.

If a parent brings you a two year old who hasn't been vaccinated what do you do? Refuse to do it because it wasn't done on time? Of course not.

For Measles and mumps, its given at age one, but you need to consider that these diseases are considered lethal for kids at that age.

I understand that, but the anti-vaxxers don't.

Now a lot of daycare centers and pre-schools won't take an unvaccinated kid... but then the parents just keep the kid home (well, OK, that somewhat limits their exposure) or just takes them to an unofficial day care where they can run around with other unvaccinated children.

Hepatitis B is transmissable from a mother to her child.

Which, if you ask me, is a good reason to immunize adults against it.

The catchup schedule exists, but there's a reason why its called the catchup schedule.

Yes, and it's dreadfully necessary in the US, between the anti-vaxxer bullshit and the fact that there are all too many children who have no access to medical care outside the ER. I have known all too many women who never saw a doctor until the day the delivered their child. I know all too many infants and toddlers who have never seen a doctor for a well baby check up. And do you know why? Because free market for-profit healthcare is SHIT. They can't afford it. So, a parent can't afford regular visits, tries to get by on underfunded free clinics, takes the kid the ER if they look really sick, and then hears all the anti-vax bullshit on the idiot box... it's a problem. One that probably doesn't exist where you are. In the US there are forty million who have no medical access unless they're dying of something acute, and they they wait for hours in an emergency room to get patched up just enough not to die when they go back out the door. Forty million.

Best healthcare system in the world my sweet ass - it's shit!

In the past few years I have helped two adult women get the vaccinations they never got as kids, they got none and one was 19 and another 20 and neither had had any vaccinations and were trying to get them because they wanted them. They had slipped through the cracks all those years, gone to church-sponsored schools that looked the other way, had had little to no doctor visits in all those years... it's just awful. Forty million people like that!

Here's another good one - check out the last post on this page. That's the bullshit I had to go through to get a tetanus shot. A fucking tetanus booster!

Sorry - yes, I get horribly, horribly angry about this. It's just fucking wrong. And there's not a goddamned thing I can do to fix what's wrong here.

edit: I would also like to add that the schedule is helpful for other reasons, as its during the first year that infants get checked up on routinely.

In your country? Sure, that's a given. In mine? not so much.

I've run into people who think that somehow vaccines weaken the immune system. In that case, you might argue that no, it's like athletic training, it gives the immune system a little exercise, which makes it stronger. Or maybe it's like a "wanted" poster - it shows the immune system what the germ looks like, so it can better recognize it and fight it better. A somewhat sloppy metaphor that gets a person to roll up their sleeve is better in this regard than a highly precise but unintelligible scientific explanation.

Just a quick question then. Isn't this how vaccines are protrayed?
Hell, its how I was TAUGHT.

Yes, it's how it's taught. Thing is, a lot of non-medical people never get the lesson. To you, it's utterly simple. To a surprising number of others... never heard of it. Yes, even in the 21st Century.

http://www.cdc.gov/vaccines/vpd-vac/var ... lt.htm#who
The CDC doesn't recommend adults get a booster either.

The recommend it if you can't demonstrate immunity. Let's take a look at that, shall we?

All children and adults without evidence of immunity to varicella need the vaccine. Evidence of immunity includes any of the following:
Documentation of two doses of varicella vaccine

Never vaccinated, so I can't produce that.

Blood tests that show you are immune to varicella or laboratory confirmation of prior disease

Never had any such test, so I can't produce that.

Born in the United States before 1980, excluding health-care workers, pregnant women, and immunocompromised persons. These individuals need to meet one of the other criteria for evidence of immunity.

Well, OK, I was born well before 1980, BUT if I turned up pregnant, got a job in healthcare, or wound up immunocompromised they'd want one of the following:

Receipt from a healthcare provider of a) a diagnosis of chickenpox or b) verification of a history of chickenpox

Let's see... the doc who diagnosed my chickpox was in his late 60's in 1975 when I had it, so he'd be about... 100 now. What are the odds he's alive? Long retired in any case. I did try to go back and get medical records from an allergist I saw back in 1978 and 1979 but guess what - clinic long closed, records long since lost or destroyed. I can't remember his name - mom might remember, except she's gone now, and dad wouldn't know because mom took care of all that. I can't provide the receipt or verification of diagnosis for practical reasons, barring renting a time machine.

Receipt from a healthcare provider of a) a diagnosis of herpes zoster (shingles), or b) verification of a history of herpes zoster (shingles).

Never had shingles, thank god for that, but since I haven't I can't provide those, either.

Great. I had chickenpox, I remember it. My family remembers it. But I couldn't document it if my life depended on it. My medical records prior to about 1995 are spotty and incomplete. That is typical of Americans my age. So if I ever apply for job in healthcare either I pay for laboratory testing out of my own pocket (see story about getting a tetanus booster for how much fun THAT would be!) or they'll just go ahead an revaccinate me, I guess. This is not how I'd set up a healthcare system, how about you?

That, and before I lost my job in the healthcare industry I saw some research indicating that either getting chickenpox or being vaccinated early might not give life-long immunity, especially if you aren't exposed to "wild" cases of the diseases. That hasn't changed the official schedules, but it wouldn't surprise me if you see that change in the next 10 years.

I think some of the anti-vaxxers got jabs as toddlers and never since, so they've forgotten that vaccines are largely non-events. Maybe if adults got shots regularly they wouldn't seem so damn scary, huh?

I can personally attest that no, it still remains as damn scary as it was the first time you get jabbed.
And given the attitudes of my colleagues, yeah.....

Since you spend far more time jabbing people with needles than I do I'll just have to defer to your greater experience. I don't like to watch the needle go in, but it's not that big a deal to me. Oh, well, obviously I don't have a needle phobia.

Come on, we handle needles all the time and there are still people amongst us who are afraid to donate blood because of said needles.

I've long thought that reluctance to deliberately cause bleeding isn't entirely irrational, it would seem to be a survival mechanism, one that has to be overcome to donate blood. A lot of people can use their intellect to make that leap, but not all of them, obviously.

[Slacker]

I'll agree with the near impossibility (or tremendous hassle, at least) in getting updates as an adult; I had to get bloodwork done recently, and the doctor noticed that my rubella titer was just a little below what was needed in order to provide immunity. Ideal is 1.00, I have .97. It's high enough that I'm probably still immune, but it's still something that should be updated. But, seeing how my doctor doesn't deal with kids, they don't stock the vaccine. But, because my insurance only allows me to deal with my primary care physician for things like immunizations, I can't actually GET a booster without going out of network, and pay something like $150 bucks for the shot. I've been meaning to contact the county board of health, and see if I can arrange something, but it's a pain in the ass.

[PainRack]

It's a ritual. You get some tribal healer to make sand paintings and chant over you it's a ritual. Cookie-white coat-stethoscope are ritual trappings, the costume and props you use to reassure people of your authority and role. It may not be what medicine defines it as, but we're not talking about a medical viewpoint - we're talking about people to whom modern medicine is magic. It's not a viewpoint you are familiar with, so it's hard for you to slip into. The jargon is different. That is, of course, why medical people have problems communicating with people with a magical mindset, it's alien to you. You keep wanting to make them see it your way, which is fairly typical of people, it's hard to really get inside someone else's worldview if theirs is very different from yours.

Ahem. I'm just pointing out to you that the word rituals in healthcare has a very different TECHNICAL term that's already being used by medical socialogists.

Of course there are problems with it, if there weren't problems with non-medical viewpoints we wouldn't have trouble getting people to vaccinate their kids. However, primitive tribesmen aren't going to get a lot of exposure to modern media, now are they? If they're used to taking the advice of the woo-woo person in the tribe and the woo-woo person won't buy into the vaccination stuff without being able to chant and make gestures or whatever the heck he or she usually does then let them do the woo-woo while you vaccinate.

I think I'm facing a miscue of some sort. Weren't you referring to primitive tribesmen as some sort of analogy?

Well, whether its true or not, just using authority to enforce health behaviour change isn't permament. Granted, we aren't talking about a constant state of change as is required for other health behaviours but...

I will certainly defer to the experts on that. However, we know that approach doesn't always work. I'm out of ideas, but I'd love for there to be an alternative that works.

Actually, it works pretty well. However not every emotion driven instinct has a reasonable outcome. Similarly, an entire population doesn't have similar emotional needs or responses.

With regards to the use of parental fear, a distrust of government officials could simply wipe out the message involved.

Unfortunately, in some places it's not being pushed at all. And FAR too much emphasis on it being to immunize against an STD. Yes, yes, I know HPV is an STD but you scare the Fundies off by saying that too strongly. If they pushed it more as a cancer vaccine I think they'd get more buy in. Yes, in a rational world people would jump at the chance to prevent STD's but it's not a rational world and in the US you have to deal with religious nutbjobs.

Different approaches then. Over here, its being pushed entirely as a cervical cancer vaccine.
Which has its own problems...

And yes, girls lose their virginity early, in their teens, but all too often parents will not let their daughters get it for fear it will give them "ideas". The way it's sold it here it makes it sound like if you don't get it by 12 it's useless. It's not. Better a young women get it at 18 than not at all, because if she's having sex at 18 she's unlikely to suddenly stop, isn't she?

Don't get so focused on the ideal that you discard less than perfect but still workable strategies.

I'm not sure whether my internet reading is more accurate than your ground reading in the States, but I simply don't see any indication that doctors don't give the vaccines at age 18 or etc. If anything, a google search reveals that the only problem is in giving it to women over the age of 26.

As for ideal vs less than working, there IS a major issue. Namely, given the relatively high prevalence of HPV infection in the population, a sexually active person with more than one partner is at high risk of being infected with the related strain . There is no data to suggest the vaccine confers any protection or advantages at that point.

Unless the parents flat out refuse to give it to a child that young. Yes, the child will be at risk longer than he or she should be, but better to be vaccinated late than not at all. There is no way to force a parent to present their child for vaccination in this country. You can't enter public school without them, but there are private schools and home schooling.

You mistake the argument entirely. Not vaccinating a kid with DPT before age 1? That's lethal.
After that? Diptheria lethality in children RAPIDLY tails off as one gets older.

To put it simply, the benefits of vaccinating a kid for DPT becomes lesser and lesser as one grows older, to the point that its non-existent. Well, apart from the tetanus bit.

Obviously, vaccinating early is best. Unfortunately, that's not the real world. Seriously, if a parent tells you they will not allow their infant to be vaccinated what are you going to do? Stick the needle in the kid when they aren't looking? Well, alright, I could argue that it's in the best interests of the child, but heaven help you if that's the one kid who will have a problem. By all means, try every argument you can to convince the parents to do it early, but it may not work.

Again, am I mistaking something on the ground? The existence of the catch up schedule exists to cover the fact that infants may not had received the vaccinations in the neccessary schedule involved.

Which, if you ask me, is a good reason to immunize adults against it.

That's ignoring the reality on the ground where a good portion of the population is already infected with Hep B. Unless you live in certain parts of Europe, segments of the population in the States, large portions of the population in Asia and Africia already have some form of hepatitis infection.

The impact of the vaccination has been long enough that we altered this significantly but until Gen Y gets out of child bearing age...........

Yes, and it's dreadfully necessary in the US, between the anti-vaxxer bullshit and the fact that there are all too many children who have no access to medical care outside the ER.

First of all, don't beat your country over this issue. Many other countries in the world need to catch up on vaccinations due to issues such as distance, access and etc.

Most of the vaccinations for a child also require boosters to stay effective and well. That's just sheer hassle.

That, and before I lost my job in the healthcare industry I saw some research indicating that either getting chickenpox or being vaccinated early might not give life-long immunity, especially if you aren't exposed to "wild" cases of the diseases. That hasn't changed the official schedules, but it wouldn't surprise me if you see that change in the next 10 years.

What you say is true. You're referring to cases in schools where chickenpox has spread to vaccinated kids. Lab work with antibody titre suggest that antibody production is tailing off... or something like that. Sorry, I can't understand anything past the abstract.

Still, at the moment, the recommendation by the experts don't include getting a booster. Let's not swing to the over end and over-medicalise issues.

Since you spend far more time jabbing people with needles than I do I'll just have to defer to your greater experience. I don't like to watch the needle go in, but it's not that big a deal to me. Oh, well, obviously I don't have a needle phobia.

It gets annoying when you have to demonstrate a s/c injection to the relatives. The best, most effective way of actually showing them is to jab someone. Patient is best, yourself if you need to.
And........ then your hand pause just as the needle skims the air above your belly fat.
Sometimes I manage to overcome it and push it through, others, screw it.

I'll agree with the near impossibility (or tremendous hassle, at least) in getting updates as an adult; I had to get bloodwork done recently, and the doctor noticed that my rubella titer was just a little below what was needed in order to provide immunity. Ideal is 1.00, I have .97. It's high enough that I'm probably still immune, but it's still something that should be updated. But, seeing how my doctor doesn't deal with kids, they don't stock the vaccine. But, because my insurance only allows me to deal with my primary care physician for things like immunizations, I can't actually GET a booster without going out of network, and pay something like $150 bucks for the shot. I've been meaning to contact the county board of health, and see if I can arrange something, but it's a pain in the ass.

That sucks.
Then again, just a quick reminder of how Singapore actually does its healthcare, we are a pay per service system for primary care. That means, hep vaccines costs 60 bucks, tetanus is 20, and , I'm so wrong regarding the cost of Gardasil that it actually cost nearly 400 dollars, not the 130-150 dollars I assumed it was(apparently, that was per shot).

[PeZook]

Many vaccines and medicine in Poland also have to be paid for, even if many are subsidized. You generally get a certain vaccine sponsored by the government: for example, I paid extra for the basic set of shots just to have it be all-in-one (so my son only got three shots instead of nine for the same set of diseases).

It's an obvious economic calculus, of course, ounce of prevention worth a pound of medicine etc - the state saves God knows how many millions by providing free basic vaccination, both in costs of care and potential future taxes.

Now some Polish perspective on Broomstick's other comments: the really, really expensive care is all covered here. Frankly, I can't imagine having to pay for treatment after being injured by a terrorist bomb ; I mean, what the fuck? I get it in the business sense, these sorts of events would require insurance companies to pay out a lot in a short period of time so they get out of it with small print. But those sort of semi-random problems is exactly the reason you want insurance! It's like fire insurance that excludes arson and lightning strikes ; What good is it then?

[Broomstick]

I think I'm facing a miscue of some sort. Weren't you referring to primitive tribesmen as some sort of analogy?

No, actually I wasn't. The Dine (a.k.a. Navajo) actually do use elaborate sandpaintings and chanting for healing purposes and MD's who work with them find they get a lot more cooperation if they are amenable to letting the tribal healers do their thing alongside the high tech medical stuff. There are a number of Christian sects that are big on healing by prayer, so again letting them set up their groups to do their thing by the patient's bedside, even if it technically violates some of the rules regarding number of visitors at once, can result in a lot more cooperation with the high tech stuff that will actually save the patient. Don't get me started on the New Age woo-woo bullshit. The Hmong that were transplanted to the US after the Vietnam War went from stone age technology to the latter half of the 20th Century which caused huge problems in regards to their interactions with medical personnel. (It is also to believed to have caused such extreme culture shock that the stress either caused or significantly contributed to a number of deaths. We've had some similar problems with the Sudanese "Lost Boys" given asylum here, although they've been handled a little differently and, being younger, were better able to tolerate that level of culture shock) "Primitive tribes", or "Ignorant sub-groups", are very real things doctors in the US have to deal with. This may be less of a problem where you are.

I will certainly defer to the experts on that. However, we know that approach doesn't always work. I'm out of ideas, but I'd love for there to be an alternative that works.

Actually, it works pretty well. However not every emotion driven instinct has a reasonable outcome. Similarly, an entire population doesn't have similar emotional needs or responses.

True, and when you start talking about all the diverse sub-groups over an entire continent it can become a minefield.

With regards to the use of parental fear, a distrust of government officials could simply wipe out the message involved.

Yes, it can - but that's another reason why in recent decades there has been a push to bring minorities into medicine. You still have to deal with people accusing such doctors as traitors to their own, and self-bias of the sort that leads to black patients demanding white doctors over black ones (which trend is getting rarer but it does happen).

I'm not sure whether my internet reading is more accurate than your ground reading in the States, but I simply don't see any indication that doctors don't give the vaccines at age 18 or etc. If anything, a google search reveals that the only problem is in giving it to women over the age of 26.

I thought the age 26 thing was based on a combination of "by that time she's probably already had the viruses" and "supplies are limited and it would have the greatest impact on those who are young and have either no or fewer partners".

I expect that there are a number of factors involved.

You mistake the argument entirely. Not vaccinating a kid with DPT before age 1? That's lethal.
After that? Diptheria lethality in children RAPIDLY tails off as one gets older.

And yet, my area recently had a woman in her 30's die of diphtheria. The news reports did note that was an extremely unusual event, but apparently the woman had never received the vaccine, not even once. Whether that was due to oversight or religious bullshit I don't know.

Even if diphtheria in an adult isn't a serious disease an adult with diphtheria could inadvertently infect an immunized child. Keeping adult immunity to diphtheria up is important as herd immunity for newborns and those who for whatever reason can't be immunized early.

We're getting that problem with whooping cough/pertussis now - there have been some outbreaks where adults had a mild form of the illness and passed it on to children who either weren't immunized or who had weakened immune systems. Failing to keep up adult immunity can result in a reservoir of infection

Obviously, vaccinating early is best. Unfortunately, that's not the real world. Seriously, if a parent tells you they will not allow their infant to be vaccinated what are you going to do? Stick the needle in the kid when they aren't looking? Well, alright, I could argue that it's in the best interests of the child, but heaven help you if that's the one kid who will have a problem. By all means, try every argument you can to convince the parents to do it early, but it may not work.

Again, am I mistaking something on the ground? The existence of the catch up schedule exists to cover the fact that infants may not had received the vaccinations in the neccessary schedule involved.

Over here, it's not unusual to find school age children or even teens that have not had their vaccinations. "Catch up" schedules extend beyond infancy.

That, and before I lost my job in the healthcare industry I saw some research indicating that either getting chickenpox or being vaccinated early might not give life-long immunity, especially if you aren't exposed to "wild" cases of the diseases. That hasn't changed the official schedules, but it wouldn't surprise me if you see that change in the next 10 years.

What you say is true. You're referring to cases in schools where chickenpox has spread to vaccinated kids. Lab work with antibody titre suggest that antibody production is tailing off... or something like that. Sorry, I can't understand anything past the abstract.

Still, at the moment, the recommendation by the experts don't include getting a booster. Let's not swing to the over end and over-medicalise issues.

Absolutely. I certainly wouldn't want to see more shots than necessary. It's just that in the old days there was enough "wild" stuff floating around that the immunized immune systems received enough stimulus to stay on alert. Declining adult immunity is actually a sign that we really are reducing the disease burden on the human race. Circumstances change, new information comes to light, and perhaps procedures need to change.

Ideally, adults should have the bloodwork to determine their immunity to some of these diseases - that way, if the immunity is still good you don't have to jab them, and if it's declining then you give them a booster as actually needed. But, alas, the world is far from ideal.

[PainRack]

And yet, my area recently had a woman in her 30's die of diphtheria. The news reports did note that was an extremely unusual event, but apparently the woman had never received the vaccine, not even once. Whether that was due to oversight or religious bullshit I don't know.

Even if diphtheria in an adult isn't a serious disease an adult with diphtheria could inadvertently infect an immunized child. Keeping adult immunity to diphtheria up is important as herd immunity for newborns and those who for whatever reason can't be immunized early.

The factor involving increased lethality in infants is due to several reasons.
Children have smaller airways, thus, children below the age of 5 has an increased mortality rate when compared to adults.
Their needs and ability to handle oxygen deprivation is different.
More importantly, unlike older children, infants CAN"T CALL FOR HELP.

That's the reason why saying oh, it isn't ideal, but we work it out is simply not desirable. Babies simply can't communicate the fact that they're choking to death.

Noticing your baby gargling or turning blue requires relatively more constant care and attention that is increasingly rare in our stressful world.