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Death toll rises

(167 Posts)
stargirl1701 Fri 30-Nov-12 11:50:01

The number of babies under 3 months who have died from whooping cough this year has risen to 13. Just so awful. My thoughts are with their families today.

stargirl1701 Mon 03-Dec-12 19:44:15

What are the long term implications of the drop in MMR vaccinations that we saw recently? A major outbreak in 30-40 years?

ElaineBenes Mon 03-Dec-12 21:59:18

No, rates aren't declining, Brycie. It's the not the driving factor behind most of the current outbreaks of whooping cough. My point in my previous post was Bruffin was right in the sense that vaccination rates CAN play a role (and also said that it's not the main cause of the current outbreaks) .

Whether you increase the suscepitble population through waning immunity or through non vaccination, the effect is the same.

IF vaccination rates decline, the outbreaks would be even worse because there would even more susceptible people.

It's an important distinction, I think, because it has an impact on the solution (let's just not vaccinate because it's not worth it vs let's give boosters to pregnant women and older kids to boost immunity).

Brycie Mon 03-Dec-12 22:09:22

If they're not declining it can't be afactor at all can it? I'm no statistician (never a truer word) but if vaccination rates were the same whether there was an outbreak or no outbreak then they can't have anything to do with it. It can't be any cause never mind the main cause. What about the other type of whooping cough - I suppose it can't be that bad or they might be offereing a vaccine or research into a vaccine.

ElaineBenes Mon 03-Dec-12 22:18:51

It's a factor in the sense that the higher the vaccination rates, the lower the probability of the outbreak.

The point is that not being the main cause doesn't negate the fact that keeping vaccination rates high still decreases the likelihood and severity of any outbreak even if immunity decreases faster than expected.

I don't know much about the other type of whooping cough either, just also heard that it's not as bad and much less likely to have complications.

CoteDAzur Mon 03-Dec-12 22:28:17

If vaccination rates of babies are at levels, than the outbreak is clearly not about vaccine refuseniks. It is about low immunity in the rest of the population - whether via waning vaccine immunity or pockets of unvaccinated.

"Vaccination rates are 'not the main cause but must play a roll [sic] somewhere' " doesn't mean anything in a context where vaccination rate is at record high.

This is important to point out because of the knee-jerk reaction of "Ooh those terrible anti-vaxers" that got touted from the 1st reply to OP on this thread.

ElaineBenes Mon 03-Dec-12 22:47:41

Unfortunately, people who don't vaccinate can no longer rely on herd immunity to protect their own babies. Probably explains the increasing rates of vaccination. I suspect the same pattern will occur any vaccine preventable disease which recurs since it's easy to forget, as a society, how nasty they are

The fact that it is not decreasing vaccination rates which explain the current outbreaks of pertussis does not detract from the irresponsibility of not vaccinating (against medical advice of course), both from the individual and community perspective.

Actually a big problem for herd immunity (natural and vaccine induced) is removing circulating disease from the equation. Doesn't mean vaccinations shouldn't be used, but does mean that those in charge of public health should be aware that waning immunity is likely to become an increasing problem. Of course this will vary from vaccination to vaccination.

Probably explains the increasing rates of vaccination. Evidence please? One reason that the rate of pertussis vaccination may have increased is that with the introduction of the aP it became impossible to get a tetanus jab (for example) for children without pertussis. Also groups for whom the wP was contra-indicated (e.g children with epilepsy) were able to receive the aP.

Incidentally I never think about herd immunity in relation to my children, I tend to think that by not vaccinating ds2 or ds3 they're at some sort of increased risk of catching the disease. This idea that people who haven't vaccinated are going round saying 'ooh it's okay because of herd immunity' is frankly bizarre. I've never met anyone who thinks like that, and it shows a complete lack of understanding as to why people refuse or delay vaccinations

Welovecouscous Mon 03-Dec-12 23:46:53

Presumably a lot of people in the 70s who weren't vaccinated against wc have had wild wc?

I was given all vax except wc as my mum's GP surgery were not offering wc as they thought it unsafe. I promptly caught wc as a baby and was pretty ill.

ElaineBenes Tue 04-Dec-12 01:10:50

Really saintly? So you made the decision not to vaccinate without considering the probability of being exposed to the disease in question?

I find that quite astonishing, especially since I remember you said that you think it was a viral infection which triggered your ds's autism.

How can you rationally weigh up the probability of death/disability when you haven't actually calculated the probability of not vaccinating which by necessity has to include the effect of herd immunity (even if only because if only partial, the effect will be to shift up the average age of infection).

Welovecouscous Tue 04-Dec-12 01:40:48

Elaine, Saintly is saying the opposite, that she did consider the risk and would assume unvaccinated children were at greater risk.

Do you have to be so sneering?

ElaineBenes Tue 04-Dec-12 02:08:58

No one is sneering! what did I say that was sneering? I certainly didn't sneer so you can stop with the dramatics.

Saintly explicitly said that she did not take into consideration herd immunity when deciding whether or not to vaccinate her children.

Of course unvaccinated children are more likely than vaccinated to contract a disease. That goes without saying, but the probability of contacting a disease is dependent on herd immunity.

I don't see how you can do a risk analysis of the benefits of vaccinating or not if you haven't even considered one of the key components determining the risk. Especially if your strategy to maximise your childrens health is to minimise exposure to all viruses, whether live attenuated or dead.

ElaineBenes Tue 04-Dec-12 02:20:41

Or rather the probability of being exposed to a disease is dependent on herd immunity, the probability of subsequently developing the disease is depending on your immune status. If you haven't considered probability of exposure than you can't work out the overall probability. That's all.

Oh Elaine stop being do obtuse. I meant that while my children remain unvaccinated I assume they are at higher risk of catching the disease than if they were vaccinated. Clearly this actual risk varies from disease to disease, but I rather assume for exam

Hate this frigging phone. I rather assume that if they meet measles they will get it. For example. (I don't assume the same of meningitis C, as that is slightly more complicated).

Anyway, I'm not going to go through each one. My point was that I didn't leave ds2 and ds3 unvaccinated thinking 'ooh hooray now I don't have to take any risk I can have all the benefits'. The thought process you ascribe to most people who don't vaccinate. Instead, like most of my friends it's a decision I worry about, a decision that I believe does lead my children at higher risk of catching the diseases in question. Unfortunately in our house 'health' is slightly more com

Slightly more complex than avoiding measles. Or mumps. Or even polio.

I am concerned about the research that is showing that mass vaccination (for some vaccinations at least) increases the severity of disease for unvaccinated individuals (compared to pre-vaccination days) and I keep an eye on it.

bruffin Tue 04-Dec-12 08:00:16

I am concerned about the research that is showing that mass vaccination (for some vaccinations at least) increases the severity of disease for unvaccinated individuals (compared to pre-vaccination days) and I keep an eye on it.

Really, nothing to do with those that are unvaccinated tend to be the most vulnerable and more likely to get severe forms of the disease in the first placehmm

No Bruffin Now this is more likely to be seen in a vaccination that doesn't give full protection. It;s early days for this sort of research, but one of the scientists involved rasies the possibility that it might be a factor for things like pertussis (which of course is problematic if the reason you haven't been vaccinated is because you are 6 weeks old).

HTH

Andrew Read's TEDMed talk is worth watching for anyone interested in this area.

Brycie Tue 04-Dec-12 10:28:45

Hi Bruffin there was a link showing that if you have pertussis vax you are more vulnerable to parapertussis. However parapertussis is much milder and not as common though it is more dangerous in babies under six months. But it's not considered as bad in any way as Elaine said as whooping cough.

Brycie Tue 04-Dec-12 10:29:45

Sorry - I meant to say the parapertussis whooping cough is not in any way as bad as the pertussis whooping cough.

JoTheHot Tue 04-Dec-12 10:53:02

SJJ You always cite Read's work to support your concerns about vaccination leading to the evolution of increased virulence. This is fine. Yet his work also shows that vaccination can equally lead to the evolution of reduced virulence. As does a host of other theoretical and empirical research. You never mention any of this. Why is this? Are you unaware of it or do you not mention it deliberately? Perhaps it's simply not 'interesting'?

No Jo, I mentioned it because Elaine was going on about assessing risk for my children. If you look back you will see exactly the context in which is was mentioned. It would have been a bit bizarre to go on about decreasing risk at that time.

bruffin Tue 04-Dec-12 10:58:31

Brycie that is not what I am referring to at all. When there is anything outbreak ie like measles in Europe last year, it sometimes appear that the rate of severe complications have gone up. This is not because the disease has got worse as the antivaxers say, but because there is a greater percentage of people catching the disease are in the vulnerable category who may be more susceptible to severe disease. It's not the disease getting worse.

This older paper provides a good summary and this is free access (presumably similar to the first one).

I find it all interesting. As you know. Which was why I lined to his TED talk as well.

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