Measles fears in the UK

This is stunning. The Beeb have a good article on it here. Don't be fooled by the headline that this is just a 13 year high. The method of collecting the data has only existed since 1995 so they only have 13 years of data. Just to give you the willies in '96 there were 112 cases. So far in '08 (10 months) there have been 1049.

Some people just need to be told to shut up and sit down. However I cannot get around the notion that people need to be smacked in the face with the truth sometimes. Perhaps vaccinations will only pick up once kids start going deaf, contracting brain damage and dying. I really don't like being that cynical either.

Yes, this story made me angry too. I just don't get people's desperate need to believe that the 'establishment' is wrong. Even worse that it's the children of these idiots that are suffering, not the idiots themselves.

People skip vaccinations, they're going to get sick. This was entirely predicable, and just goes to show what giant, irresponsible asshats the anti-vaccination lobby is.

Zelos wrote:

Yes, this story made me angry too. I just don't get people's desperate need to believe that the 'establishment' is wrong.

Erm, well there have been some instances. A few scandals amongst many, DDT, thalidomide, testing of radioactive compounds on orphan children, nuclear veterns, air safe to breathe at ground zero. All treated for years in a 'move along, nothing to see here' manner.

I completely agree that scaremongering is terrible and causes great harm, but I do feel people have a right not to be test subjects. It comes down to being informed and having confidence in that information. If there is a problem it is with sensationalist media stories and poor communication of the presence of absence of scientific data.

They are quoting health experts. I work under the assumption that vaccinations only stop the spread of the disease and not really from catching it. The vaccination doesn't actually stop you from contracting the disease, at least in the case of the Measles.

Either way, you have 3 million kids in the UK alone who are open not just to measles but mumps and rubella. I think its fair to call that a potential epidemic even if the vaccination do offer 100% protection.

Conglacio wrote:
Zelos wrote:

Yes, this story made me angry too. I just don't get people's desperate need to believe that the 'establishment' is wrong.

Erm, well there have been some instances. A few scandals amongst many, DDT, thalidomide, testing of radioactive compounds on orphan children, nuclear veterns, air safe to breathe at ground zero. All treated for years in a 'move along, nothing to see here' manner.

Fair point, although I think there is more to it than that - Charlie Brooker on conspiracy theories makes some good points about people latching on to things like this because it makes them feel special (http://www.guardian.co.uk/commentisfree/2008/jul/14/september11.usa).

Not to mention the scaremongering on the part of this story about an epidemic.

EDIT: Probably more explanation is due here. The vaccination is only about 95% effective in the first place. Immunizing everyone is impossible; there are certain sub-populations (allergies to eggs, HIV-infected, pregnant women) where immunization is considered too dangerous to perform. At least 90% of people who get measles recover without any treatment, and are then immune. That number is old - even fewer need to be hospitalized now. The only serious issue with measles is that it can lead to getting pneumonia. Since that risk is greatly mitigated by staying warm and hydrated, the risk in a modern first-world country is phenomenally low. Other complications are so statistically unlikely that they can't be studied properly. In third-world countries, measles is considered such a low risk that they don't even try to immunize for it.

In short, there's no story here. There's no epidemic, and even if there were an outbreak of the disease that spread to every single person who wasn't immunized, it would have a negligible impact - far less than say, car accidents or sports injuries, even across the same population. Spending a ton of money immunizing mostly already-immunized people and trying to scare people with the threat of an epidemic is also irresponsible.

Aetius wrote:

In short, there's no story here. There's no epidemic, and even if there were an outbreak of the disease that spread to every single person who wasn't immunized, it would have a negligible impact - far less than say, car accidents or sports injuries, even across the same population. Spending a ton of money immunizing mostly already-immunized people and trying to scare people with the threat of an epidemic is also irresponsible.

That's a little different from what Wikipedia says:
Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading to corneal scarring[4] Complications are usually more severe amongst adults who catch the virus.

According to the World Health Organization (WHO), measles is a leading cause of vaccine preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO).

Zelos wrote:
Aetius wrote:

In short, there's no story here. There's no epidemic, and even if there were an outbreak of the disease that spread to every single person who wasn't immunized, it would have a negligible impact - far less than say, car accidents or sports injuries, even across the same population. Spending a ton of money immunizing mostly already-immunized people and trying to scare people with the threat of an epidemic is also irresponsible.

That's a little different from what Wikipedia says:
Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading to corneal scarring[4] Complications are usually more severe amongst adults who catch the virus.

According to the World Health Organization (WHO), measles is a leading cause of vaccine preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO).

The two highlighted qualifiers are being used to make it seem to be much more serious than it is. Almost all of the complications are due to poor conditions to begin with - a situation that simply does not apply in England. Running immunizations in countries that haven't been immunized yet and have very poor health conditions is not a terrible thing (though it strongly contributes to overpopulation, sort of a catch-22), but panicking over tiny numbers of cases in a first-world country is just silly.

Aetius wrote:

Probably more explanation is due here. The vaccination is only about 95% effective in the first place. Immunizing everyone is impossible; there are certain sub-populations (allergies to eggs, HIV-infected, pregnant women) where immunization is considered too dangerous to perform. At least 90% of people who get measles recover without any treatment, and are then immune. That number is old - even fewer need to be hospitalized now. The only serious issue with measles is that it can lead to getting pneumonia. Since that risk is greatly mitigated by staying warm and hydrated, the risk in a modern first-world country is phenomenally low. Other complications are so statistically unlikely that they can't be studied properly. In third-world countries, measles is considered such a low risk that they don't even try to immunize for it.

In short, there's no story here. There's no epidemic, and even if there were an outbreak of the disease that spread to every single person who wasn't immunized, it would have a negligible impact - far less than say, car accidents or sports injuries, even across the same population. Spending a ton of money immunizing mostly already-immunized people and trying to scare people with the threat of an epidemic is also irresponsible.

Are you familiar with the concept of herd immunity? It's precisely because the vaccine isn't 100% effective, and that some can't be immunized that it's important that everyone that's able to take vaccines do so. Most might recover without ill effects, but people who needlessly put their children and people around them at risk are still phenomenally stupid.

Alien Love Gardener wrote:

Are you familiar with the concept of herd immunity? It's precisely because the vaccine isn't 100% effective, and that some can't be immunized that it's important that everyone that's able to take vaccines do so. Most might recover without ill effects, but people who needlessly put their children and people around them at risk are still phenomenally stupid.

In the specific case of measles, there are two major factors that make this a non-issue. One is that measles cannot be eliminated; there have been spontaneous outbreaks in places where immunization rates have been extremely high, usually among the non-immunized, with no source traced to outside interference. Measles, and especially rubella, are some of the most infectious viruses known to man. The immunizations themselves are not effective enough to reach the herd immunity threshold, and it is unlikely that they will ever reach it. So we're already in the situation where we can't use herd immunity to eliminate the virus, with no likely change in the foreseeable future. We're already at the highest level of effectiveness that we can reasonably achieve.

The second factor is what I stated - measles are relatively mild in first-world countries because we recognize the disease and take steps to reduce the patient's exposure to the symptoms that kill people in countries where the disease is common. Measles itself doesn't kill, unlike smallpox; it causes bodily responses that lead to death if you don't deal with them, such as diarrhea and susceptibility to respiratory infections. Deal with those via hydration, adequate shelter, and sanitation, and the threat decreases to a very low level.

None of this changes the fact that people who don't get immunized are taking a risk. But it's not a societal risk, and it is certainly not a risk worth bringing up the specter of epidemic. You run the risk of crying wolf too many times, and then when something serious happens (like the return of smallpox, for example), people won't listen. That's a real threat. This is not.

Eh? An epidemic is a situation situation where the number of new cases of a disease significantly exceeds the norm. If the estimates are correct and there's 30 000-100000 new cases in the UK, it is an epidemic because the norm has been under a thousand for the time they've been keeping track, regardless of whether it actually kills someone or not. Epidemic has nothing to do with bodycount, despite the sinister connotations of the word.

It might not be possible to eradicate measles, but greater rates of immunization will keep the spread in check, and avoid putting a lot of unecessary, easily avoidable stress on the healthcare system.

A major outbreak of measles won't be the end of the world, but it would be unpleasant, and mostly caused by stupidity.

Vaccines offer an effect much like the network effect with software and communication devices, but in reverse; even a small percentage increase in un-immunized people can greatly accelerate and worsen the spread of disease. It's critically important to get every single person possible.

There is a tiny risk with vaccines, but it's far lower than the risk of the disease itself.

I think it's unethical to refuse a vaccine that's proven to work, particularly the ones we've been using for decades already. If you refuse, you become a leech: you are free-riding on the risk that everyone else around you took, betting that their risk will protect you, but without providing any benefit in return. It's extraordinarily selfish.

The measles vaccine comes with the vaccines for mumps and rubella, both of which are very dangerous diseases. There's just no reason to refuse that vaccine when it's coming with others as well. The overall risk is the same.

Liberty is something to always strive for, but there's a huge social benefit to immunizations, and the risk and/or inconvenience to individuals is tiny. It's okay to expect certain basic behaviors to participate in society. You run a risk of being in a car accident and dying on the way to the DMV to renew your license -- a higher chance than that of having an serious adverse reaction to a vaccine -- but that's a risk that everyone accepts.

With liberty comes responsibility, and you seem to want to abdicate the latter. You're fighting bitterly here for an exceedingly foolish thing. You're trying to assert a freedom that is not meaningful -- the freedom from the measles vaccine, which isn't even separate from the mumps and rubella vaccines -- as being more important than the general welfare.

I'm fairly libertarian, but I see no problem whatsoever with mandatory vaccinations -- at gunpoint, if necessary. Failing to vaccinate yourself means you're not paying your own way in society, which is about as anti-Libertarian an idea as exists.

Alien Love Gardener wrote:

Eh? An epidemic is a situation situation where the number of new cases of a disease significantly exceeds the norm. If the estimates are correct and there's 30 000-100000 new cases in the UK, it is an epidemic because the norm has been under a thousand for the time they've been keeping track, regardless of whether it actually kills someone or not. Epidemic has nothing to do with bodycount, despite the sinister connotations of the word.

If that's true, then we are having an epidemic of the common cold and we should do something about it. Be serious. There will not be 30,000 new cases in the U.K. It's not going to happen. And even if it did, it would be a non-event. If anything, a thousand people getting infected means that an epidemic is less likely than it was before, since there are fewer possible vectors now and they would have been high-risk vectors to get infected in the first place.

It might not be possible to eradicate measles, but greater rates of immunization will keep the spread in check, and avoid putting a lot of unecessary, easily avoidable stress on the healthcare system.

A major outbreak of measles won't be the end of the world, but it would be unpleasant, and mostly caused by stupidity.

Doubtless, but the stress on the healthcare system is miniscule, because most people who are infected don't need to be treated.

Malor wrote:

Vaccines offer an effect much like the network effect with software and communication devices, but in reverse; even a small percentage increase in un-immunized people can greatly accelerate and worsen the spread of disease. It's critically important to get every single person possible.

I'm not arguing against vaccines (except in specific cases, which measles is not). I'm arguing about the definition of the word "possible" in your statement.

I think it's unethical to refuse a vaccine that's proven to work, particularly the ones we've been using for decades already. If you refuse, you become a leech: you are free-riding on the risk that everyone else around you took, betting that their risk will protect you, but without providing any benefit in return. It's extraordinarily selfish.

Without question.

The measles vaccine comes with the vaccines for mumps and rubella, both of which are very dangerous diseases. There's just no reason to refuse that vaccine when it's coming with others as well. The overall risk is the same.

I would disagree with your characterization, but ok.

Liberty is something to always strive for, but there's a huge social benefit to immunizations, and the risk and/or inconvenience to individuals is tiny. It's okay to expect certain basic behaviors to participate in society. You run a risk of being in a car accident and dying on the way to the DMV to renew your license -- a higher chance than that of having an serious adverse reaction to a vaccine -- but that's a risk that everyone accepts.

All true.

With liberty comes responsibility, and you seem to want to abdicate the latter. You're fighting bitterly here for an exceedingly foolish thing. You're trying to assert a freedom that is not meaningful -- the freedom from the measles vaccine, which isn't even separate from the mumps and rubella vaccines -- as being more important than the general welfare.

Did I assert that people should not take the vaccine? No. What I'm saying is that bringing up the specter of an epidemic is ridiculous; there's no change in threat, other than a minor reduction due to new immunized individuals!

I'm fairly libertarian, but I see no problem whatsoever with mandatory vaccinations -- at gunpoint, if necessary. Failing to vaccinate yourself means you're not paying your own way in society, which is about as anti-Libertarian an idea as exists.

If it was smallpox ... yes. Measles does not warrant that kind of behavior. I agree that failing to be vaccinated is stupid, but in this case, in England, saying there is going to be an epidemic is ridiculous fearmongering. This is a public health issue, and they are expending their reputation on something that is totally irrelevant to their society.

Look, if we were really serious about getting rid of measles, there's an easy way to do it. Vaccinate as many people as you can. Then expose the entire population to the measles. Sure, a few people will die or get hurt, but overall, it'll stop the spread of the disease for good. Do the same to all new babies - vaccinate, and then expose. Why don't we do this? Because we aren't cold-blooded bastards. Until we're willing to be, until you are willing to force someone to take a vaccination for a non-fatal disease, then we have to deal with what people are willing to do, and what resources we are willing to expend trying to fix something that is not a problem.

Aetius wrote:
Alien Love Gardener wrote:

Eh? An epidemic is a situation situation where the number of new cases of a disease significantly exceeds the norm. If the estimates are correct and there's 30 000-100000 new cases in the UK, it is an epidemic because the norm has been under a thousand for the time they've been keeping track, regardless of whether it actually kills someone or not. Epidemic has nothing to do with bodycount, despite the sinister connotations of the word.

If that's true, then we are having an epidemic of the common cold and we should do something about it. Be serious.

It is the definition of the word.

dictionary.com wrote:

1. Also, ep⋅i⋅dem⋅i⋅cal. (of a disease) affecting many persons at the same time, and spreading from person to person in a locality where the disease is not permanently prevalent.
–noun
3. a temporary prevalence of a disease.

wikipedia.com wrote:

In epidemiology, an infection that is epidemic (from Greek epi- upon + demos people) appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is "expected," based on recent experience (the number of new cases in the population during a specified period of time is called the "incidence rate"). (An epizootic is the analogous circumstance within an animal population.) In recent usages, the disease is not required to be communicable.
Contents

Defining an epidemic can be subjective, depending in part on what is "expected". An epidemic may be restricted to one local (an outbreak), more general (an "epidemic") or even global (pandemic). Because it is based on what is "expected" or thought normal, a few cases of a very rare disease like rabies may be classified as an "epidemic," while many cases of a common disease (like the common cold) would not.

The common cold would be endemic.

IMAGE(http://i29.photobucket.com/albums/c273/echoguitar/the_more_you_know2.jpg)

The guardian's science take on it all (and many more media driven health/science scares):
http://www.badscience.net/category/mmr/

or just

http://www.badscience.net/

Silly Americans and Europeans think that companies experiment with vaccines they get, they do that to poor Africans, not Americans and Europeans who can sue.

Alien Love Gardener wrote:

Eh? An epidemic is a situation situation where the number of new cases of a disease significantly exceeds the norm. If the estimates are correct and there's 30 000-100000 new cases in the UK, it is an epidemic because the norm has been under a thousand for the time they've been keeping track, regardless of whether it actually kills someone or not. Epidemic has nothing to do with bodycount, despite the sinister connotations of the word.

If that's true, then we are having an epidemic of the common cold and we should do something about it. Be serious.

It is the definition of the word.

dictionary.com wrote:

1. Also, ep⋅i⋅dem⋅i⋅cal. (of a disease) affecting many persons at the same time, and spreading from person to person in a locality where the disease is not permanently prevalent.
–noun

My point is that we consistently have "epidemics" of various viruses that are lumped under the "common cold" moniker that no one even bothers to identify properly because there is no body count and there is no danger. One of these just went through North Carolina, and no one cared. These people are specifically raising the fear that a lot of people are going to die from the measles if the disease spreads, and that's not true in England. Fearmongering is wrong no matter who does it.

Aetius, the reason colds are not "epidemic" is that bit about "in a locality where the disease is not permanently prevalent". That is, if something is endemic, as the cold viruses are all over the world, then it's not an epidemic. Besides, measles is much more dangerous than the common cold or the flu. Case fatality is 1% - 5% in developing countries, with 5% - 10% getting pneumonia. An estimated 242,000 children died of measles in 2006. This reflects a 68% reduction in cases from 2000.

The mortality of the 1918 flu pandemic was around 2.5%.

The dangers of only vaccinating in certain countries should be obvious with air travel and a four day symptom free contagious period. And the cost of treatment far exceeds the cost of prevention. Measles prevention is not a vanity vaccine or a frivolous gouging by the drug companies. It's a real threat, one that killed American children even when I was a child (just as whooping cough killed my mother's friends when she was in grade school). Measles vaccination is a good thing.

Robear wrote:

Aetius, the reason colds are not "epidemic" is that bit about "in a locality where the disease is not permanently prevalent". That is, if something is endemic, as the cold viruses are all over the world, then it's not an epidemic. Besides, measles is much more dangerous than the common cold or the flu. Case fatality is 1% - 5% in developing countries, with 5% - 10% getting pneumonia. An estimated 242,000 children died of measles in 2006. This reflects a 68% reduction in cases from 2000.

And all of those children are in countries that are not England. Measles is not more dangerous than the flu in developed countries, and in any case, neither of them are a serious threat any more to first-world societies.

The dangers of only vaccinating in certain countries should be obvious with air travel and a four day symptom free contagious period. And the cost of treatment far exceeds the cost of prevention. Measles prevention is not a vanity vaccine or a frivolous gouging by the drug companies. It's a real threat, one that killed American children even when I was a child (just as whooping cough killed my mother's friends when she was in grade school). Measles vaccination is a good thing.

Again, I'm not arguing that. I know that measles vaccination is a good thing, and that it is not smart to avoid it. I've stated that several times already. In England, however, measles is not a threat. And the cost of treating those last few people will far, far exceed the cost of the vaccine. Are we willing to force them to do it?

Measles kills almost entirely because the people who get it do not have adequate hydration, adequate nutrition, or adequate shelter. In first-world countries, deaths from measles are essentially zero, and will remain at essentially zero even if there is an epidemic, and even if they do not get any medical treatment at all (in fact, the required medical treatment is trivial - antibiotics to prevent secondary infections). In fact, an epidemic would probably be a good thing for England, because it would immunize almost all of those who refuse vaccination without costing the state anything. The only thing the health services are accomplishing by crying epidemic is giving ammunition to the people who are refusing vaccination. They will turn around next year and say "The health service said there was going to be an epidemic, and there wasn't! They are lying again!" That is counter-productive. Both sides of the debate are trying to use unreasonable fear to get their way, and that is wrong.

In first-world countries, deaths from measles are essentially zero, and will remain at essentially zero even if there is an epidemic, and even if they do not get any medical treatment at all (in fact, the required medical treatment is trivial - antibiotics to prevent secondary infections).

And yet one in a thousand get encephalitis. That's not going to change. As well, the antibiotics, time of care and other services including hospitalization have a cost. And with assumed full vaccination coverage, public education efforts stop, and parents may way too long to get their children checked for a cold with a high fever, yielding similar results to those in less developed countries (and a cost to deal with them, even if the life is saved). Which leads back into "preventable" treatments not being applicable. So now we're back to vaccination and public education.

It's not fear, it's economics. We save money (and quality of lives) with vaccination even in developed countries.

Anyway, that's my position.

Aetius wrote:

In fact, an epidemic would probably be a good thing for England, because it would immunize almost all of those who refuse vaccination without costing the state anything.

Wait, them getting sick is a good thing, because it immunizes them, and it costs the state nothing? But if it doesn't really matter if people get sick, why would those people being immunized be important? And does treating people far, far exceed the costs of the vaccine, or cost the state nothing?

I'm confused.

The only thing the health services are accomplishing by crying epidemic is giving ammunition to the people who are refusing vaccination. They will turn around next year and say "The health service said there was going to be an epidemic, and there wasn't! They are lying again!" That is counter-productive. Both sides of the debate are trying to use unreasonable fear to get their way, and that is wrong.

They're not saying that an epidemic *will* happen, they're saying there's a risk. Given the upswing in vaccinations, they can easily point to that as preventing an epidemic. I don't buy that as convincing many people at all.

EDIT: Also, I don't buy the equivalence drawn here. "MMR vaccines cause autism!" and "People not getting vaccinations will risk an epidemic, and potentially serious complications" are substantially different because the former is completely baseless fearmongering and the latter is true.

I went back and re-read the numbers, Aetius. They say that one in four kids isn't properly MMR-immunized, and that this could cause between 30k and 100k cases of the disease. That's not fearmongering, that's just math. 75% coverage is not enough to prevent transmission.

Measles is pretty damn serious, even if it's not commonly fatal anymore, and a hundred thousand cases is a big damn deal. I don't know what you're arguing about here, but I think that qualifies as an epidemic, and it's a huge cost they shouldn't have to bear. A $5 shot is a hell of a lot less expensive than a hospital stay.

I see no fearmongering here, just simple math. 100k extra cases of FLU would be a big deal, and measles is a lot worse than that.

Malor wrote:

I went back and re-read the numbers, Aetius. They say that one in four kids isn't properly MMR-immunized, and that this could cause between 30k and 100k cases of the disease. That's not fearmongering, that's just math. 75% coverage is not enough to prevent transmission.

Neither is 100% immunization.

Measles is pretty damn serious, even if it's not commonly fatal anymore, and a hundred thousand cases is a big damn deal. I don't know what you're arguing about here, but I think that qualifies as an epidemic, and it's a huge cost they shouldn't have to bear. A $5 shot is a hell of a lot less expensive than a hospital stay.

Most people who get measles will never see the hospital. It isn't necessary. So you can't say there is a 1-to-1 equivalent of the $5 shot versus the hospital stay. And again, you also can't compare the $5 shot to forcing people to comply - that is pretty expensive too.

I see no fearmongering here, just simple math. 100k extra cases of FLU would be a big deal, and measles is a lot worse than that.

Neither one would have a significant impact on the country in any way.

Aetius wrote:
Malor wrote:

I went back and re-read the numbers, Aetius. They say that one in four kids isn't properly MMR-immunized, and that this could cause between 30k and 100k cases of the disease. That's not fearmongering, that's just math. 75% coverage is not enough to prevent transmission.

Neither is 100% immunization.

Is proves over decades to reduce the number significantly close to 100%.

Aetius wrote:

Most people who get measles will never see the hospital. It isn't necessary. So you can't say there is a 1-to-1 equivalent of the $5 shot versus the hospital stay. And again, you also can't compare the $5 shot to forcing people to comply - that is pretty expensive too.

1 in 10 suffer serious complication even when they are cared for well. So lets take 10 kids. €/$50 cover them all. Given the numbers of Measles when the take up for vaccinations was around 100% was close to zero lets just assume, for this example that the €/$50 covers them all.

Now lets not vaccination all of them. Now 9 of them get the Measles and they have a few days off school. Not too bad and have a story to tell their mates. I'm with you as far as this point. However one kid develops serious complications has to attend a hospital. What the cost of one night stay? I'm betting its multiples of €/$50.

Even if the vaccinations don't cover you too 100% perfectly it makes perfect sense that it saves you vast sums in the future.

Aetius wrote:
Alien Love Gardener wrote:

I see no fearmongering here, just simple math. 100k extra cases of FLU would be a big deal, and measles is a lot worse than that.

Neither one would have a significant impact on the country in any way.

My mother was a nurse. Retired now but she would go ape at people cramming A&E (ER over here) with frivolous conditions as it causes people to make mistakes which results in people not getting the right treatment. In A&E that is very serious.

Now for most A&Es a bad Saturday night can stretch them. A flu epidemic of 100k will cause serious problems to country the size of the UK as for young kids and the elderly the flu is dangerous. That's why vaccinations are given in schools and nursing homes over here as its proven to be cost effective. Measles running as about 100k would be quite serious. Not preventing against it is, too my mind, equivalent to not insuring your car. You might get away with it but you are really stacking the odds against yourself.

Axon wrote:

1 in 10 suffer serious complication even when they are cared for well. So lets take 10 kids. €/$50 cover them all. Given the numbers of Measles when the take up for vaccinations was around 100% was close to zero lets just assume, for this example that the €/$50 covers them all.

Now lets not vaccination all of them. Now 9 of them get the Measles and they have a few days off school. Not too bad and have a story to tell their mates. I'm with you as far as this point. However one kid develops serious complications has to attend a hospital. What the cost of one night stay? I'm betting its multiples of €/$50.

And how much would it cost to force the people who refuse to take the vaccine to take it? Legal fees? Police time? Bad publicity? Someone getting hurt? Giving the anti-vaccination crowd an excuse to gather more members and more money?

Even if the vaccinations don't cover you too 100% perfectly it makes perfect sense that it saves you vast sums in the future.

Of course it does, which is why we try to vaccinate as many people as possible. But we're talking about the difference between the scenario where you force the remaining unvaccinated people to take the vaccine, and the scenario where you leave them alone to get sick because they aren't worth the effort. Which of those is cheaper and more effective for overall public health?

Aetius wrote:
Alien Love Gardener wrote:

I see no fearmongering here, just simple math. 100k extra cases of FLU would be a big deal, and measles is a lot worse than that.

Neither one would have a significant impact on the country in any way.

Now for most A&Es a bad Saturday night can stretch them. A flu epidemic of 100k will cause serious problems to country the size of the UK as for young kids and the elderly the flu is dangerous. That's why vaccinations are given in schools and nursing homes over here as its proven to be cost effective. Measles running as about 100k would be quite serious. Not preventing against it is, too my mind, equivalent to not insuring your car. You might get away with it but you are really stacking the odds against yourself.

The U.K. has a population of 50 million people. 100k getting sick means that 0.2% of the population is sick. Do you remember the Great Flu Epidemic of 2000 in the U.K.? No? There were at least 150k cases, and some people were claiming more than that - doctors were telling people with symptoms to stay home, because everyone was taking advantage of their "free" health care and getting in the way of the people who really needed help. Nothing broke down, very few people died, and it has since been forgotten. There are around 20,000 people who have gone to the doctor with the flu in the U.K. right now, which means probably twice that many have it. 50,000 or so get it every year even in the good years. In fact, the number of active cases never really goes below 10,000.

Perspective, people, it's a useful thing.

Here's the CDC's take on measles.

Since monovalent vaccines containing measles, rubella, and mumps vaccine viruses -- and subsequently combined measles-mumps-rubella (MMR) vaccine -- were licensed, the numbers of reported cases of measles, mumps, rubella, and congenital rubella syndrome (CRS) have decreased by more than 99%. In 1993, the Childhood Immunization Initiative established goals of eliminating indigenous transmission of measles and rubella in the United States by 1996. Subsequently, the goals of the initiative were extended to include reducing the number of reported mumps cases to less than or equal to 1600 by 1996. U.S. Public Health Service year 2000 objectives include eliminating measles, rubella, and congenital rubella syndrome, and reducing mumps incidence to less than 500 reported cases per year. Since 1995, fewer cases of measles, rubella, and mumps have been reported than at any time since nationwide disease reporting began, and elimination of indigenous transmission appears feasible. These recommendations are intended to hasten the achievement of these disease elimination goals. Measles Clinical Characteristics

The incubation period of measles (rubeola) averages 10-12 days from exposure to prodrome and 14 days from exposure to rash (range: 7-18 days). The disease can be severe and is most frequently complicated by diarrhea, middle ear infection, or bronchopneumonia. Encephalitis occurs in approximately one of every 1,000 reported cases; survivors of this complication often have permanent brain damage and mental {ableist slur}ation. Death occurs in 1-2 of every 1,000 reported measles cases in the United States. The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents. The most common causes of death are pneumonia and acute encephalitis. In developing countries, measles is often more severe and the case-fatality rate can be as high as 25%.

When you talk about 30,000 cases in the UK, that's equivalent to 180,000 in the US. That would be a complete failure in the effort to eradicate or minimize the disease. Death or encephalitis occur in 2-3 cases per 1000 in the US. As a comparison, the death rate for children and adolescents due to flu is near zero. So for *children*, measles is a much more serious issue than flu. Which is why we vaccinate them for it and not flu (unless of course they have other risk factors like asthma).

It's all about perspective. For children, measles and flu are not comparable risks. So here's a question for you - what rate of vaccination will yield an acceptable result? You talk about leaving alone those who don't want it, but then will you deny them medical care at taxpayer expense? Or are you taking from us to heal them as a result of their choices?

No matter how you cut it, some people's "freedoms" cost other people money. Forced vaccination (as happens now with schools not admitting unvaccinated kids) is not nearly as onerous as you argue, and it's not very costly. But hospitalizing thousands of kids is costly.

Robear wrote:

When you talk about 30,000 cases in the UK, that's equivalent to 180,000 in the US. That would be a complete failure in the effort to eradicate or minimize the disease. Death or encephalitis occur in 2-3 cases per 1000 in the US. As a comparison, the death rate for children and adolescents due to flu is near zero.

They are both so close to zero that it doesn't matter. 56,000 people died in the 2006 flu season, which was light, 68 of whom were children. For measles, using 180,000 people as the infected population, that puts deaths or brain damage at ... 360. Not even a blip on the radar to a nation of 300 million people. In fact, the kids would probably be safer staying out of the hospital. More people than that die from gravity every year. It's a total non-threat.

It's all about perspective. For children, measles and flu are not comparable risks. So here's a question for you - what rate of vaccination will yield an acceptable result? You talk about leaving alone those who don't want it, but then will you deny them medical care at taxpayer expense? Or are you taking from us to heal them as a result of their choices?

Sigh. I've said several times already that I'm not talking about enforcing their freedom or whatever. I'm arguing that it is not worth it to go after them. It doesn't make sense, both from a epidemological view or a financial view. Think about what you are asking. We would have to find out who they are, and go individually to their homes and force them to take shots. And we'd have to do it twice for every single of them. If they get sick, a few will die and the rest will be immune. It's a problem that will solve itself if it occurs, with an impact that will be entirely unnoticeable to the general population.

And yes, I would deny them health care, at taxpayer expense or with insurance paying. Not taking the MMR vaccine is stupid, unlike the flu "vaccine", and no insurance company or government should have to pay for treating it after the fact.

No matter how you cut it, some people's "freedoms" cost other people money. Forced vaccination (as happens now with schools not admitting unvaccinated kids) is not nearly as onerous as you argue, and it's not very costly. But hospitalizing thousands of kids is costly.

I have repeatedly said that this is not about freedom, this is about practicality. And even with 180,000 infected kids (which we'll never see), you're only talking about 1800 in the hospital and 400 or so dying - maximum. Since we don't have any good recent statistics, I would be willing to bet that the rates are much smaller these days, with better nutrition and better hydration. That is not a threat to the U.S. or the U.K.. The U.S. lost 56,000 people to pneumonia and flu in 2006 and no one even cared except the people doing the statistics.

I'm not talking about the kids who get vaccinated to enter school - I'm talking about the people who refuse vaccination and don't send their kids to school. Who is going to go find them and make them take the vaccine? How many man-hours would that take? How effective would it be? There isn't a chance that it'll get us over the herd immunity threshold, and it would be stupidly expensive, especially considering the other things those people could be doing while they are wasting their time trying to solve a problem that doesn't need to be solved.

As a take-away, have a look at this graph.

Aetius wrote:

Sigh. I've said several times already that I'm not talking about enforcing their freedom or whatever. I'm arguing that it is not worth it to go after them. It doesn't make sense, both from a epidemological view or a financial view. Think about what you are asking. We would have to find out who they are, and go individually to their homes and force them to take shots. And we'd have to do it twice for every single of them. If they get sick, a few will die and the rest will be immune. It's a problem that will solve itself if it occurs, with an impact that will be entirely unnoticeable to the general population.

I think you're responding to an imaginary argument. I don't think anyone will disagree that hunting down people who hadn't had their measles shots and forcing them to take it wouldn't be worth it in terms of cost/benefit, but nobody has argued for that either. People have taken issue with your assertions that this isn't noteworthy, and that the media are irresponsible scarmongers for reporting on the situation and the risk for an epidemic.

Alien Love Gardener wrote:

I think you're responding to an imaginary argument. I don't think anyone will disagree that hunting down people who hadn't had their measles shots and forcing them to take it wouldn't be worth it in terms of cost/benefit, but nobody has argued for that either. People have taken issue with your assertions that this isn't noteworthy, and that the media are irresponsible scarmongers for reporting on the situation and the risk for an epidemic.

Alien Love Gardener wrote:

It might not be possible to eradicate measles, but greater rates of immunization will keep the spread in check, and avoid putting a lot of unecessary, easily avoidable stress on the healthcare system.

How exactly do you propose to increase the rate of immunization?

And I have yet to see someone present any numbers that show that an "epidemic" would put at risk more than .001% of the population. How is that a story? How is that a threat to the nation? Show me where that would fit in a list of the top 100 causes of death in England. Would it even be on the list?