To think perhaps schools should insist on vaccinations.

[Lovestonap]

Good animal boarding kennels etc will not take animals without their vaccinations up to date.
Should our schools be able to insist on a completed course of childhood vaccinations (up to age appropriate) before giving a space at a school? Obviously children who are unable to be vaccinated would have a medical exemption certificate. I think this would be a good idea, but then I'm wondering if this is a nanny state too far thing. Probably implications for human rights I haven't considered.

Just read that there is an outbreak of mumps at Liverpool University. Most of the students there will have been born around the time of the Wakefield controversy, so there is a good chance that some of them won't have had the MMR.

Eastie

Nobody’s suggesting that mandatory vaccination for school entry would eliminate transmission - sadly there will be continue to be selfish fools who would rather home ed than do the sensible thing. But it would greatly reduce it. Children being closely around each other in classrooms and assemblies so obviously promotes transmission that it’s amazing anyone would think differently. Measles would spread much more slowly without school as a node for transmission.

And that doesn’t take account of the vulnerable children in school who can’t be immunised and who deserve protection infinitely more than anti-vaxxers deserve their ‘freedom of choice’, which of course it isn’t at all: it’s a freedom to dangerously freeload off others.

This also answers your point about outbreaks in the US. (You may notice that outbreaks are most common in the US where ‘crunchy’ parents congregate.). Anyway, outbreaks are fewer in the US than here because of their more sensible policies, including school vaccination.

As to how to speak to anti-vaxxers, these people can’t be reasoned with and will take calm and sympathetic replies as proof of their delusional, selfish views. They need to be opposed strongly.

I’m pretty horrified by the suggestion that parents should be coerced or forced into giving their children any invasive medical intervention, and I say that as someone whose children are vaccinated and so would be admitted to school. I think it sets a very dangerous precedent to defer parental responsibility to experts unconditionally (mistakes are made occasionally) and to give up bodily autonomy for the sake of the ‘greater good’. I also back calls made further up thread for more honest discussion on both sides and a more sensible, moderate debate. For every rapid antivaxxer claiming vaccines are a big pharma conspiracy there is a rapid provaxxer claiming that vaccine reactions are so vanishingly rare they’re not worth considering. Neither view is helpful (or true).

The outbreaks of Mumps we’ve been seeing in recent years are due to waning immunity as well as missed and incomplete vaccination (although in many cases people were following the schedule of the time) - basically people who had the MMR as infants are no longer immune as its worn off, and that is pretty well documented. There was discussion about moving the second MMR dose to adolescence but that would leave children vulnerable to Measles so they left it as it is. It’s a clear disadvantage of combining the vaccines in this case, but we are where we are and have to live with it.

I don’t actually know anyone who said no to vaccines completely, but know plenty of parents who vaccinate selectively or on an extended schedule (including myself). In all cases this has been a direct result of experience of children having a had time with vaccines, particularly now, in the Men B era. Serious adverse events (mainly high fever, which is a big deal for a two month old) are approximately 1 in 200 according to recent estimates. Dismissing concerns as idiocy, sometimes very aggressively, isn’t going to override parents direct experience. A more honest assessment of risks and benefits is needed, including acknowledgement of the risks and limitations of vaccines. I suspect most people would still feel vaccines are worth the risk (as I did) but would at least feel as though they weren’t being patronised or misled.

Prequelle So what's the answer? Leave the pro-vaxx mama bear advocates to it? I think it is absolutely possible to create a pro-vaccination community to combat the anti-vaxxers. It would just take the time and effort to put proper strategies in place. Parents do not vaccinate their children for a number of different reason and health bodies should recognise this and strategise accordingly rather than putting them all in a single bucket .

There are parents who are not anti-vaxx and haven't fallen prey to conspiracy theories but refuse to vaccinate because they are worried about side effects. Others have concerns around the composition of vaccines. Some just need gentle persuasion. Obviously there will be always be parents who will always refuse to be convinced but I'm convinced that a better, targeted effort will work.

As pointed out, the anti-vaxxers have carefully cultivated a message of 'empowerment' and 'taking back control' from medical professionals and Big Pharma.

The pro-vax response to that to date has been "just vaccinate your child. Adverse reactions virtually never happen and even if they do it's still better than your child getting the disease". That isn't working is it?

Banning unvaccinated children from school would lead to a massive increase in the anti-vaxx movement's popularity imo.

Incidentally my GP told me he had measles and he was fine. He told me if my DC caught they probably would be too. There were no scare stories. However he carefully explained the other risks, the secondary effects, what happens when herd immunity drops below a certain level. All of this might be common sense to you but I needed it spelt out and what was empowering for me was feeling my concerns were heard.

There aren't significant outbreaks where I live because of my state laws, in other states there are other rules. I also don't live in a state which attracts anti-vaxers I suspect.

Insisting on basic safety measures isn't unusual, what is surprising is that the US is so much more advanced in this than the UK. In transitioning to the US I have found this isn't usually the case.

I don't think you can successfully build a pro vax community that could rival an anti vax. Because antivaxxers talk about so much amongst themselves, they seek support about the newest woo, ask each other what herbs to treat what symptom, have full on discussions about conspiracies and pat themselves on the back an awful lot for being 'woke'.

What's a provaxxer group going to be like? Because it'll only ever have been created to combat the anti Vaxxers. It won't be a support community like anti vaxx are because apart from being able to offer peer reviewed research, people wouldn't be qualified to give medical advice and unlike antivaxxers won't make it up as they go along. Anti-vaxx communities thrive because they are limited in where they can go for help whereas we just... go to medical professionals.

I'm also not entirely sure it's up to the common folk to be responsible for educating those who have un-educated themselves

I wonder if there are other options apart from vaccine/no-vaccine?

What if controlled exposure to the disease was offered? So an anti-vaxer had the option to be exposed to wild measles and quarantined at home until they were no longer contagious.

They would be immune for life, we would have some real data on the effects of measles in a presumably healthy population, and the herd would be protected.

controlled exposure is a bad idea.
it's not just the risk of death but also the risk of long term damage.
for measles the statistics are horrific.

just get the jab if you can.

[https://ecdc.europa.eu/en/news-events/measles-outbreaks-still-ongoing-2018-and-fatalities-reported-four-countries ecdc]]

greenelephantscarf

Sure, but as "just get the jab" clearly doesn't seem like a good choice for some, what are other options?

There are no other options. You get your children the jabs or you don’t. And if you don’t, please don’t complain if you’ve made your children ineligible for school, if that policy is ever brought in here.

So an anti-vaxer had the option to be exposed to wild measles and quarantined at home until they were no longer contagious

An option to purposely make their child ill and at risk of death. Amazing.

And what about vaccines for things like Hep B? HPV? How will that work

What a load of unsubstantiated drivel posted as always. There are still no studies showing that the MMR is less dangerous than getting measles especially given that long term adverse effects of measles are vanishingly rare in children with adequate levels of vitamin A
physiciansforinformedconsent.org/measles/?gclid=EAIaIQobChMIuqDjqe_O4AIVTrvtCh0hIAogEAMYASAAEgLLZvD_BwE

And this is how measles used to be viewed before the introduction of the vaccine and the bla tang scaremongering of the general populous into submission

An option to purposely make their child ill and at risk of death. Amazing.

I always wonder about parents who do measles parties. If a child is intentionally infected with measles and suffers disability, of which there’s a real likelihood, the parents must have opened themselves up to ruinous lawsuits by the child down the line.

It’s that sort of possibility for suing for foreseeable harm that I’d like to see opened up for anti-vaxxers’ unfortunate children and the families of others whose lives are wrecked by anti-vaxxers.

I think the answer to that is in the basic epidemiology.

Even in the well nourished, previously healthy populations, 1:1000 of those contracting the disease will die. About 10:1000 will have lasting (possibly life changing) complications.

Serious adverse events from MMR are about 1:1000. Death and SSPE do not occur, though the risk of severe anaphylaxis is present.

cathmidson are you being serious? Look at the mortality rates for measles and look at the ones for MMR. Your answer lies there. People are STILL dying from measles.

kissing I agree. I'm not happy about an increasing litigious society but for things like this, people need protection

@Kissingintherain.... and the children damaged by vaccines forced by the state?

Dear Editor,
We commend Doshi on citing “insufficient evidence” for a benefit from mandatory influenza vaccination in healthcare workers and exposing conflicts of interest. [1] In the same vein, our organization has found that it has not been proven that the MMR vaccine results in less death or permanent disability than what is expected from measles.[2] The risk of dying or suffering permanent injury from measles in the United States was very small, even before the measles vaccine was introduced in 1963. Therefore, vaccine safety studies must show that the risk of dying or suffering permanent injury from the MMR vaccine is even smaller.

In the late 1950s and early 1960s, right before the measles mass vaccination program was introduced, the chance of dying from measles was 1 in 10,000 or 0.01%.[3] However, the public is generally unaware of this figure as the CDC publishes case-fatality rates based on the number of reported cases only. Since it is estimated that nearly 90% of measles cases are benign and therefore not reported to the CDC, the widely publicized measles case-fatality rate is 10 times higher than what is actually found in the general population.

Furthermore, a large 2004 Danish epidemiological study published in JAMA found that the risk of febrile seizures after MMR vaccination is 1 in 640[4] —a five-fold higher risk of febrile seizure than the risk of seizure from measles.[5] Vestergaard et al. studied the association between MMR and seizures in about 537,000 Danish children 0 to 14 days following MMR vaccination and found 1.56 MMR-related febrile seizure cases per 1,000 vaccinated children aged 15 to 17 months (95% CI, 1.44 to 1.68). Vestergaard’s results are based on 973 febrile seizures within two weeks of MMR vaccination, a robust database containing about 18,000 febrile seizures, and a nonvaccinated control group of about 98,000 children. Applying the 1 in 640 risk of febrile seizure to the 3.64 million U.S. children (91% vaccination rate applied to 4 million children[6]) vaccinated with MMR every year results in about 5,700 annual MMR-related seizures.

Measles surveillance in the 1980s and 1990s revealed that there are 3 to 3.5 times more measles seizures than measles deaths.[5] Therefore, because the measles case-fatality rate is 1 in 10,000, the seizure rate from measles is 3 to 3.5 in 10,000 (mean 1 in 3,100). Although 1.56 MMR-related febrile seizures in 1,000 (about 1 in 640) is a small risk, it is five-fold higher than the 1 in 3,100 risk of seizures from measles.[5] In addition, a significant portion of febrile seizures have permanent sequelae. A large 2007 epidemiological study found that 5% of febrile seizures result in epilepsy.[7]

A query of the Vaccine Adverse Event Reporting System (VAERS) for symptoms involving seizures and convulsions from all measles vaccines (for U.S. children age 6 months to 2 years, between 2011 and 2015) results in about 90 seizure reports per year.[8] This is only 1.6% of the about 5,700 expected MMR-related seizures based on Vestergaard’s findings. Other serious vaccine adverse events after MMR, including deaths, may similarly be underreported.

As with mandatory influenza vaccination, there is insufficient evidence that mandatory measles vaccination results in a net public health benefit.

Sincerely,
Shira Miller, M.D.
President, Physicians for Informed Consent

References:

1. Doshi P. The unofficial vaccine educators: are CDC funded non-profits sufficiently independent? BMJ 2017; 359:j5104. www.bmj.com/content/359/bmj.j5104.

1. Physicians for Informed Consent. Measles – Vaccine Risk Statement (VRS). Oct 2017. www.physiciansforinformedconsent.org/measles/vrs.

1. Physicians for Informed Consent. Measles – Disease Information Statement (DIS). Oct 2017. www.physiciansforinformedconsent.org/measles/dis.

1. Vestergaard M, Hviid A, Madsen KM, Wohlfahrt J, Thorsen P, Schendel D, et al. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA 2004;292(3):351-357. www.ncbi.nlm.nih.gov/pubmed/15265850.

1. Centers for Disease Control. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington D.C.: Public Health Foundation; 2015. 209-15. www.cdc.gov/vaccines/pubs/pinkbook/meas.html.

1. Centers for Disease Control. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington D.C.: Public Health Foundation; 2015. Appendix E-8. www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-fu....

1. Vestergaard M, Pedersen C, Sidenius P, Olsen J, Christensen J. The long-term risk of epilepsy after febrile seizures in susceptible subgroups. Am J Epidemiol. 2007 Apr 15;165(8):911-18. doi.org/10.1093/aje/kwk086.

1. CDC wonder: about the Vaccine Adverse Event Reporting System (VAERS). Atlanta: Centers for Disease Control and Prevention [cited 2017 Nov 14]. wonder.cdc.gov/vaers.html.

Competing interests: No competing interests

If a child at school had a serious nut allergy other children would not be permitted to spread nuts around the school. In fact I am aware some schools have banned nuts.

So why do we allow children to spread life threatening diseases around a school and endanger the lives of other children with serious conditions.

Unvaccinated children have no place in a public school.

Oh no, Cath’s here. It’ll go hatstand.

Dodgy anti-vaxx links alert!

Prequels.. people are still dying from measles in developing nations in the same way they are dying from many other illnesses caused by lack of sanitation, nutrition and clean water.

Measles had declined massively in developed countries before mass vaccination campaigns and would have undoubtedly decreased even further.
Scarlet fever is very rare these days and never fatal... it used to be a killer... there was never a vaccine for it .... the decline not due to antibiotics as the first antibiotic wasn’t prescribed until 1943 and in any case SF is caused by strep which still lives in the nose and throat of most people .... who don’t develop SF

I now cannot take you seriously given in one breath you say there's no evidence of measles being more dangerous than the MMR, then in the next admitting thousands are dying from it.

PIC are, to put it more politely than Cath is apparently capable of, not uncontroversial

have you heard of virus shedding

What a load of crap Cathmidston, your just spreading antivaxxer fake news.

The measles and mumps vaccines do not shed at all. 'Signs' of rubella can be found from 7 to 28 days after immunisation but at levels far too low for anyone to catch it.

Oh well done, you found one of hundreds of debunking sites aimed at discrediting any doctor or scientist daring to speak out against vaccination... this is why doctors are afraid to speak out and remain quietly anti vax like my GP