Some anonymous person asked me on Dr Bob's board whether I did not think that unvaccinated children should see a doctor when they are sick (well, anon phrased a bit differently, but I guess this is what s/he meant).
Of course they should. Every child has the right to adequate medical care. However, every parent who has a sick child has to think for a moment, before they haul it to the pediatrician:
Could my child be contagious? Could this be something dangerous to the other kids in the practise?
Parents of unvaccinated children have more dangerous diseases to consider than parents of vaccinated children - some parents do not think first. In the year 2000, an unvaccinated preteen came down with a fever and parents took him to a pediatrician's practise. He infected six children in the waiting room with measles, three of these children were under 12 months old. Two are now dying.
This is Micha in April 2005, about a year after the onset of his SSPE. He was 5 months old when he contracted measles in that practise (ETA: this movie needs a RealPlayer plugin):
The average survival time after onset of SSPE is 4 years. Micha is still alive. He is not better. He needs to take strong medication to keep the seizures at bay.
This is Natalie - she was 11 months old when she contracted measles from the same unvaccinated preteen. She came down with SSPE in Summer 2007:
The movies are in German, the mothers talk about the healthy children they had, their dreams and aspirations, watch for a minute or two to understand why we think that:
If parents think they know enough about measles not to vaccinate their children, they should recognize the signs of the disease and have a doctor who does home visits for medical care.
Catherina
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So two children of the six infected came down with SSPE? That is *horrifying!*
Yes it is. The actual risk of developing SSPE after measles infection in infancy has been calculated to be as high as 1 in 2000 (we will blog on measles and SSPE soon). This means, once your baby has recovered from measles, you have to worry about SSPE for another decade. Germany has had about 190 SSPE cases in the last 20 years and what is very scary is that for every SSPE case, you have to assume 10 direct measles fatalities.
I very strongly feel that the overall risk is nothing that parents trying to make a vaccine decision for their children can reasonably assume, and most probably ignore the risk of transmission, like they were living in a bubble.
Catherina
catherina, how large is the risk of vaccine related SSPE?
Anon,
the short answer is 0. I am working on the long answer as a blog (SSPE and MIBE after measles and/MMR vaccine). In the MMRII package insert, Merck estimates a risk of about 1 case of SSPE in 1 million vaccinees, however, this is based on a CDC report from 1988, when scientists still had to rely on temporal associations (difficult enough in a condition that has an onset delayed by up to a decade or more). In the meantime (over 20 years have passed), we can genotype the measles virus from the brains of SSPE patients and vaccine virus has NOT EVER been found. Therefore, the working answer is 0 (longer answer to come hopefully early next week).
Well, while your example is sad, you are also very much forgetting something. What you are forgetting to mention is that vaccination is not 100%. And MOST parents think they are. So it's also quite conceivable that a sick vaccinated child could be brought to the doctor's office with a VPD and risk exposing other unvaccinated children, partially vaccinated or too young to be vaccinated.
I think you need to also put some energy into educating parents that vaccination is not 100% and that bottom line, ANY sick child is potentially a risk to other regardless of vaccination status.
Anonymous,
strangely enough, it was NOT a vaccinated child who brought measles into the doctor's office. If you look at outbreak reports, it hardly ever is a (fully) vaccinated child/adult who brings measles to the vulnerable. In fact, I cannot think of a similar situation where the index case had been vaccinated.
I agree that if your child looks like s/he could be contagious, you should call ahead and warn the office. It does not change the epidemiology of measles though and the fact that in this case, the decision of one family not to vaccinate their child is costing two other families a child. There are a number of ways in which this could have been prevented. 2xMMR is one.
You are specifically referencing measles but then are also painting a broad picture about all diseases, all parents who don't vaccinate. This MAY be the case for measles that it was not a vaccinated child who brought it in. But you are not just talking about measles. You blog is about al parents who do not vaccinate. You give ONE example of measles and SSPE. This is not right. You need to give a balanced account including how children who are vaccinated are silent reservoirs of disease, of how they can carry diseases asymptomatically and pass them on to under vaccinated or too young to be vaccinated. This is the information that most vaccinating parents do not know and because of these kinds of posts, feel self-righteous in pointing all fingers at unvaccinated, not realizing that their children are NOT 100% protected nor that their children are not disease free just because they are symptom free.
This blog piece is just more of the same biased reporting.
Anonymous, you are constructing a strawman, I wrote quite clearly that:
However, every parent who has a sick child has to think for a moment, before they haul it to the pediatricianThat reflects my opinion and what I tell parents: if your child could be contagious, call the practise, do not go straight in. However, the fact remains that parents of unvaccinated children have more and potentially more dangerous diseases to worry about and a much higher likelihood that it is something like measles than parents of a vaccinated child.
The question of "silent reservoirs" is a separate issue that we will address in the future, especially for pertussis. It does not really apply to measles in a quantitative manner.
As you mention self-rightiousness, I should add that I pity the parents of the unvaccinated index case. I am sure that they never once thought about the harm their decision could cause and they have to live with the guilt for the rest of their lives. However, this example should serve as a warning to every parent, but especially those whose children are most susceptible to measles, to think twice before taking their child with high fever into an ER or pediatrician's office. With the current accessibility of information via modern media, no parent can claim they were not aware of the potential deadliness of their actions.
no strawman .... not everyone can diagnose if a disease is contagious. Hell, it even took Mexico and the CDC some time to determine what this flu was and just how contagious it was. Not all VPD's initially present with clear symptoms which will indicate what disease it is. Your article needs to be re-written to specifically address measles in doctor's office. You are trying to target too many things at once. You are ignoring that even a partially vaccinated child could be responsible for the spread of serious diseases and could carry guilt as well for the spread of diseases.
not everyone can diagnose if a disease is contagious. ..snip.. Not all VPD's initially present with clear symptoms which will indicate what disease it is.My point precisely. You do not know what it is and at that point, *any* parent needs to think about the possibility of their child being contagious AND the unvaccinated child has a higher likelihood of having contracted a VPD than the vaccinated child. I think I said that already.
The above is an example of what can happen if parents 1. do not vaccinate and 2. do not think before they take their child into a waiting room. Therefore, nothing needs to be rewritten.
I would like to know why an unvaccinated infected kid would be more contagious than a vaccinated infected kid. And with 6 vaccinated kids getting infected, what does that say about the protection that vaccinations provide (or don't
)?
I am new to this blog, but have found this entry to be very interesting. Correct me if I am wrong, but at least 3 of the six children that were infected were under 12 months of age. Therefore, they most likely had not received the measles vaccine. I can't see the movie, but would like to know the ages of the other 3 children. I'm interested to know the ages of the other three children. It is very likely that even over 12 months of age they may have not gotten their measles vaccine yet.
I would like to know why an unvaccinated infected kid would be more contagious than a vaccinated infected kid. And with 6 vaccinated kids getting infected, what does that say about the protection that vaccinations provide (or don't)?
As far as measles, it should be obvious why an infected unvaccinated child would be more contagious than vaccinated one. If a vaccinated child contracts measles, it is due to primary vaccine failure, which does happen in a very small percentage of children. There weren't 6 vaccinated children infected, they were all unvaccinated and some too young to be vaccinated. Herd immunity should have protected them, that is, if it was present.
Anonymous (from 4 Aug) - I do not know the ages of the other 3 children, I will try to find out and get back to you.
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That seems incredibly rare statistically that two of those six kids infected by the pre-teen would later develop SSPE. So sad.
I'm wondering why people bring their kids to the doctor so easily anyway. Unless the kids look really ill, develop worrysome symptoms, and/or you can't keep any food or liquid down them, why not just stay home and let the illness run its course.
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