[fnordfnordfnord]

20-ish cases is not what I would call a big outbreak. Some of those affected in Texas had received vaccinations, but for whatever reason[1], weren't protected.

[1] I guess they had either neglected to get a booster, were not scheduled to receive the full series of shots, or the vaccine's efficacy isn't what it is claimed to be.

>My anecdotal experience among anti-vaccination people I've known is that they're only weakly correlated with religion or politics

Here is another anec-data point for you. I'm not anti-vaccine, but I am more skeptical / cautious than most (we selectively decline / delay vaccinations). I am also Atheist. My impression is that the skepticism is rooted more in lack of trust in authorities, than religion.

[pkennedy]

I guess I need to dig deeper with that case, but 20 symptomatic cases is probably linked to many others exposed and needing monitoring and prophylactic care[1]. So maybe not big, but not tiny either.

[1] for example, this case that happened in my old town had 3 symptomatic, but 175 or so others needing treatment: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a3.htm

And I totally get the skepticism of authorities thing. I only developed what trust in medical authorities I have after doing prepress work on a lot of medical textbooks and getting more familiar with the literature. Frankly most of us don't have a chance of keeping up with the state of the field when even professionals can barely keep up.

[cloverich]

> we selectively decline / delay vaccinations

Interested to hear your justification for declining / delaying vaccine's, but not considering yourself anti-vaccine.

[fnordfnordfnord]

>Interested to hear your justification for declining / delaying vaccine

I'm interested to hear why a five minute old infant is at risk of contracting Hep-B. Our kids will get Hep-B before they start school. Even if one of our kids did contract Hep-B, it is pretty unlikely that they will be able to give it to your children.

Rota-virus vaccine was suspended by the FDA temporarily,[1] We opted to decline this one even after the suspension was lifted considering seriousness of intussusception[2][3] compared the very low incidence of death or serious injury by rota-virus infection in the US. Even though the suspension wasn't related to the earlier intussusception problem, I considered the incident sign of poor QC and/or a lack of respect for the FDA by the manufacturer. We would probably reconsider if we had plans for international travel with the children, even though our oldest has probably been exposed/infected. (a fun story!) (It sure would be nice if antibody testing were cheap and widely available).

Seasonal Influenza - Declined based on personal negative experience and systematic reviews of vaccine efficacy[4][5]. Every single seasonal influenza vaccine I have taken has resulted in a miserable two-week flu-like state. I have never had a case of the flu as that was as unpleasant as my reaction to the vaccine. I understand most people are not affected so negatively by the vaccine. After reading the Cochrane reviews on the subject, I am inclined to believe that the seasonal Influenza vaccine is an unnecessary and rarely useful product.

Not that I need to worry about it yet, but Cervarix and especially Gardasil seem to have low efficacy WRT to the (possible) risks of the vaccine, especially considering the prognosis for those that contract cervical cancer (women rarely die of cervical cancer). I also find Merck's relationship over the matter with my state's idiot Governor particularly aggravating.

So, basically, if the risk of contracting and or having the illness is low, and if it doesn't needlessly endanger others (like MMR refusal for school-aged children) then I am going to take a good hard look at whether we really need the vaccine.

>not considering yourself anti-vaccine.

Anti-vaccine means you don't allow yourself or your children to be vaccinated. Our children do receive most vaccines at the scheduled time. We have opted to delay or forgo a few vaccines. Lumping people into two opposing factions has had a very negative effect on the debate, as it tends to do in a debate on any subject.

[1] http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedP...

[2] https://www.ncbi.nlm.nih.gov/pubmed/22293889

[3] http://www.fda.gov/BiologicsBloodVaccines/Vaccines/Questions...

[4] 'Flu vaccine doesn't help elderly' http://www.ncbi.nlm.nih.gov/pubmed/20166072

[5] Please read the author's conclusions for this one. 'Vaccines for preventing influenza in healthy adults.' http://www.ncbi.nlm.nih.gov/pubmed/20614424

[dalke]

"I'm interested to hear why a five minute old infant is at risk of contracting Hep-B. "

Because a baby whose mother is infected with Hep-B can be infected at birth, it's estimated that only 50% of the pregnant women who have Hep-B are identified, and babies can get Hep-B from other family members and caregivers.

See http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf for the full details, but here are two relevant passages:

> Even with improvements in the management of pregnant women, only approximately 50% of expected births to HBsAg-positive women are identified (on the basis of application of racial/ ethnic-specific HBsAg prevalence estimates to U.S. natality data) for case management, which maximizes timely delivery of postexposure immunoprophylaxis (11; CDC, unpublished data, 2004). The need for proper management of women without prenatal care, including HBsAg testing at the time of admission for delivery and administration of the first dose of vaccine to infants <12 hours of birth, is underscored by the higher prevalence of HBsAg seropositivity among these women than among women who are screened prenatally (12). Even when maternal HBsAg testing does occur, certain infants of HBsAg-positive mothers do not receive postexposure immunoprophylaxis because of testing errors and lapses in reporting of test results (13), and infants of women with unknown HBsAg status at the time of delivery often do not receive a birth dose of vaccine (14).

> Children who are not infected at birth remain at risk from long-term interpersonal contact with their infected mothers. In one study, 38% of infants who were born to HBsAg-positive mothers and who were not infected perinatally became infected by age 4 years (64). In addition, children living with any chronically infected persons are at risk for becoming infected through percutaneous or mucosal exposures to blood or infectious body fluids (e.g., sharing a toothbrush, contact with exudates from dermatologic lesions, contact with HBsAg-contaminated surfaces). HBV transmission rates to susceptible household contacts of chronically infected persons have varied (range: 14%–60%) (65,66). High rates of infection also have been reported among unvaccinated long-term residents of institutions for the mentally handicapped (67,68), and, in rare instances, person-to-person transmission has been reported in child care settings (69,70).

Also, the vaccine is made from virus capsid protein expressed in Baker's yeast. There's no infectious material at all, making it a very safe vaccine. (Unlike the earlier Hep-B vaccine which had a danger of including viral DNA should something go wrong during purification.)

[fnordfnordfnord]

>Because a baby whose mother is infected with Hep-B

Well, we didn't elect to deliver in the back room of a whorehouse, or under a tree on the prairie. We went to one of the best hospitals in the country, where blood tests are done in advance of delivery, where these things are discussed and planned as part of the pre-natal pregnancy care.

Wife and I are both vaccinated, and apparently Hep-B negative. I have to make sure my kids aren't raped by Hep-B positive child-rapists, which is sadly too common.

> There's no infectious material at all, making it a very safe vaccine.

You keep missing something from my posts. I don't doubt the science behind vaccines. You don't need to convince me that vaccines are practically a modern miracle. I lack confidence in manufacturers, and in fairness of the NVIC.

[dalke]

The document I linked you to, "Recommendations of the Advisory Committee on Immunization Practices (ACIP)", does not base its decisions on the number of childhood rapes by people with Hep-B, nor on the "number of babies delivered in the back room of a whorehouse." Why do you believe those are critical factors in the decision?

You seem to think that Hep-B is only spread through sex and drug use, and from the mother through childbirth. This is incorrect. For example, one of the citations in the above report was to http://www.ncbi.nlm.nih.gov/pubmed/2626287 . It seems some 30% of Hep-B infections come from unknown sources.

> We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected.

Before the vaccine, some 24,000 children got Hep-C each year. That's down about 90%.

As to the "very safe vaccine", nothing in that last line was meant to imply that you needed any sort of religious faith in vaccines nor that you doubted the science. It was meant to explain why failures by the manufacturer are less likely to lead to severe adverse effects than with the older vaccine. This is an engineering consideration and not a science one.

The previous vaccine was only "safe", and not "very safe." The older vaccine started with blood serum from people who had Hep-B, and purified it so only Hep-B proteins remained. This has a risk of infection should something go wrong in the purification process so that the full virus - or other viruses - somehow get through. This sort of failure would be very risky for newborns.

But the current vaccine, which is based on a genetically modified form of Baker's yeast, does not come from human sources. Since human viruses aren't in the source material, they can't enter the vaccine. There can still be other failure modes, but the most fatal - introduction of virulent particles directly into a newborn baby - can't happen through a process failure during vaccine manufacturing.

Think also of the oral polio virus. This uses an attenuated virus, that is, a mutant form of the polio virus which infects the child, but doesn't cause the symptoms. The child's immune system produces the same antibodies at it would the wild-type virus, which provides immunity. The problem is, the attenuated virus mutates in the body, and it can mutate towards a form which is deadly. This happens about once every 750,000 cases.

Again, this is not the type in the modern Hep-B vaccine - there is no infectious material at all - making it safer than oral polio virus. That's why I said Hep-B is "very safe."

[fnordfnordfnord]

>The previous vaccine was only "safe", and not "very safe." The older vaccine started with blood serum from people who had Hep-B, and purified it so only Hep-B proteins remained. This has a risk of infection should something go wrong in the purification process so that the full virus - or other viruses - somehow get through. This sort of failure would be very risky for newborns.

>But the current vaccine, which is based on a genetically modified form of Baker's yeast, does not come from human sources. Since human viruses aren't in the source material, they can't enter the vaccine. There can still be other failure modes, but the most fatal - introduction of virulent particles directly into a newborn baby - can't happen through a process failure during vaccine manufacturing.

That is interesting and reassuring to learn. Thanks, I will also pass it on to Mrs. Fnord.

[cloverich]

Thank you for the candid and well-cited response!

> So, basically, if the risk of contracting and or having the illness is low, and if it doesn't needlessly endanger others (like MMR refusal for school-aged children) then I am going to take a good hard look at whether we really need the vaccine.

But there-in lies why I would label you anti-vaccine. If the risk of disease is relatively low, you decline vaccine's - regardless of whether or not they are safe (e.g. " Gardasil seem to have low efficacy WRT to the (possible) risks of the vaccine").

> Anti-vaccine means you don't allow yourself or your children to be vaccinated.

To me, and most medical professionals, Anti-vaccine means you default to declining a vaccine, which you seem to do, despite no evidence of harm from the vaccine, and good evidence for safety.

[venomsnake]

Well ... it is simple math. If the vaccine is effective 95% (pretty good on its own) and you come in contact with 10 sick people you have a good 40% chance to catch it.

That is the whole things with vaccines - the herd immunity is as important in protection as the vaccine itself. It is virtuous positive feedback loop.

[bobbydavid]

This is the part most people don't get, on either side. You're vaccinated? Not a magic bullet, you rely on others around you. Not vaccinated? You're putting others in danger, not just yourself.

A vaccine doesn't have to get anywhere near 100% protection to be effective - it just has to drop the viral coefficient below 1.

[warfangle]

Vaccines don't work 100% of the time. That's why you shoot for herd immunity.

Vaccines aren't to keep individuals from getting sick; they're to prevent outbreaks and pandemics.

That they prevent most people who receive them from getting sick is an added benefit.

[fnordfnordfnord]

>That they prevent most people who receive them from getting sick is an added benefit.

You'll have a lot better luck selling vaccines to people if they provide a direct benefit.

[warfangle]

I'm not a salesman.