Measles cases at Mass. General, MetroWest Medical Center

The Boston Business Journal reports on the confirmed cases in the last half of August.



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Maybe, maybe not

Likely, yes, but there are sometimes breakthrough cases in vaccinated populations.

For example, somebody with immune compromise might be vaccinated but still unable to mount sufficient immune response to prevent symptoms. This happened to one of my son's friends who was fully vaccinated (the parents are definitely NOT anti-vaxxers) - he had been hospitalized for an asthma exacerbation and was on heavy doses of immune-suppressing drugs at the time. People receiving chemotherapy fall into this group, too, as do people with poorly controlled HIV infection or other innate or acquired immunodeficiency.

Of course, a fully vaccinated population can help prevent these cases ... as in people with measles aren't in the hospital to infect people with dysfunctional immune systems.

Several people I know who are my age caught measles in their 20s despite being vaccinated (workplace outbreak), because nobody knew that the immunity waned over time. We were the first age group to be vaccinated in the late 1960s - my 5 years older husband just got measles and mumps, and my older brother was vaccinated when the vaccines came available. Now people get a booster in adolescence or early adulthood.

There are a lot of people age 55 and older who were never vaccinated because the vaccines weren't around until they were older and never required, and they were somehow never infected, either.

Finally, there is a very small subgroup of people who cannot be vaccinated as they are allergic to one or more vaccine components.

So, one case of measles may or may not be due to anti-vaxxers. Outbreaks, however, are usually the direct result of groups of people not being vaccinated.

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Are you a professional nitpicker?

The vash majority of outbreaks of diseases we've immunized for here in the US are CAUSED by people who were not immunized and travel to other countries. They may SPREAD to the people you mention, but "patient zero" is almost always someone who travels, was not vaccinated, and brings back a disease.

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Full information != nitpicking

Sorry if reality is more complicated than you would like.

I am a public health professional. The anti-anti-vax brigade has its own mindless rage zealots, however, and some reason should be applied before judgement is rendered because ignorant accusations can be very damaging to individuals and communities.

I agree with you about the "unvaccinated person travelling abroad" issue. Although that "unvaccinated person" is not infrequently an older than 55 lifelong resident and citizen of the US - such as the medical professor who exposed an entire national multi-university meeting that I attended to Whooping Cough that he picked up in China (I had had my booster because my department head imported Whooping Cough from Latin America several years prior ... but many people had to get theirs and didn't even realize that they should do so regularly throughout adulthood!)

Adults over the age of 55 are an incredibly under-vaccinated group, yet there is little awareness because they are assumed to have had these "childhood" diseases and yet many have not because of extensive and compulsory vaccination of the under-45 cohort.

The lesson being that adults need to talk to their physician about boosters, because not all doctors realize the risks for their adult patients who travel internationally.

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herd immunity

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Herd immunity is what protects the vulnerable individuals you describe. People who cannot be vaccinated, who were never vaccinated, or in whom the vaccine is not effective, are protected indirectly by the fact that their vaccinated neighbors cannot get sick and cannot infect others.

The percentage of the population that needs to be vaccinated for herd immunity to occur varies with the infectiousness of the disease, i.e. how easy it is to spread. Measles and pertussis, for instance, are fairly easy to spread, requiring a vaccination rate of 92-94% for herd immunity to be effective. The anti-vax movement has now succeeded in getting the vaccination rate for measles and pertussis in some communities below that level. If it were just them and their kids at risk, I wouldn't care, but there are the susceptible individuals you described whom they have nonconsensually put at greater risk by their belief in this junk "science".

This is what happens when people take medical advice from celebrities like Jenny McCarthy and from the blogosphere, rather than from actual doctors and medical researchers.

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Medical professionals are to blame too for anti-vaxxers

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It's become pretty common practice for primary care physicians to tell parents that vaccines never cause developmental or other problems. Then the family meets someone whose child had a documented vaccine reaction and now has a severe neurological disability, and no longer believes that vaccines are safe, so they assume their doctor is misinformed and they go somewhere else to get their information.

I mean, measles itself is way more likely than the measles vaccine to cause severe neurological disabilities, but providers need to TELL PEOPLE THAT, rather than telling them that vaccines never harm anyone, which just is false and sets up this us-versus-them mentality where people think that the medical establishment is withholding information.

Medical providers also need to stop telling anti-vaxxers that they won't be able to enroll their child in school. Anyone with a google machine can find out that people can claim religious exemption just by writing a letter stating that they have a sincerely held belief, so then people think the doctor is a crock of shit and are less likely to work with them on spacing out vaccines or something that makes them more comfortable, and more likely to just up and go to Jenny McCarthy's website for their medical advice and stop seeing medical professionals all together.

It's just poor public health to insult people's intelligence and disrespect their ability to make their own choices for their children. I disagree with the anti-vax movement, but I have to say that most of the families I've worked with who have held this belief are reasonable people, didn't hold it pre-kids, and developed it after a pattern of disrespect and misinformation from doctors.

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