I am the herd

by @NTNUhealth 19 February 2015

Signe ÅsbergBlogger: Signe Åsberg,
PhD student at CEMIR


In December last year an outbreak of measles started when a family that was not vaccinated visited Disneyland California. I’m currently a visiting graduate student here in Los Angeles and I’d planned to go to Disneyland to get some of that Christmas magic-feeling that the decorated palm trees couldn’t convey.

I never went though. Before I even knew it Christmas had passed, January gone and nearly a hundred persons had been infected with measles after the outbreak that started in Disneyland.

… people who choose not to vaccinate their kids for religious or “personal reasons”

Ei jenter får vaksine. Foto: iStockPhoto

Measles are effectively prevented by vaccination and there is no cost involved (Photo: iStock)

In the following months the disease spread and 2015 is expected to be a record year in the number of cases since measles was declared eradicated in the US in 2000. What I find especially aggravating is that measles are effectively prevented by vaccination and there is no cost involved. The vaccine is part of the vaccination program, as it is in Norway, yet there are several schools and kindergartens in California where dangerously few children are vaccinated. Their parents are mainly wealthy and well educated people who choose not to vaccinate their kids for religious or “personal reasons”. Parents need only a signature from a doctor or other type of health care provider to exempt their kid from vaccination and it seems like this signature is given out too easily.

The debate following the outbreak has to a large extent focused on parents right to choose and there is a strong tradition for valuing freedom of choice in the US. But when it comes to diseases such as measles, polio and whopping cough the parents that «feel vaccination is not for them» are putting more vulnerable individuals at risk. For herd immunity to be efficient against measles at least 95-97% of the population needs to be vaccinated. This is enough to prevent an outbreak and protect those who can’t be vaccinated due to health reasons, such as the very young or old, cancer patients or people with reduced immune function.

When I started working at a major private hospital in Beverly Hills/West-Hollywood I was strongly encouraged to take the flu vaccine. After doing so I was given a green card to hang beside my employee ID card, that must be worn visibly at all time. The green card says “2014-2015» and signals to everyone that I’m vaccinated. I’m almost proud of it, feeling «approved» for the coming year. Everyday I see those green cards hanging along my colleagues IDs and anyone without it is not allowed to work with patients. That is how important vaccination is: it allows us to save millions of lives with a small pinch of a needle.

green card for vaccination

Approved for 2014-2015

After this experience I was surprised to find that there is a significant anti-vaccination movement in California with people who continue to believe in well-debunked myths about vaccination and measles. The anti-vaccine movement even receives support from some celebrities with the recent Hollywood premiere of an anti-vaccination documentary.

As has been clarified so many times: the measles vaccine does not cause autism. And measles is not a minor child disease. It is extremely contagious and has a long incubation period during which it is still contagious. The WHO estimates that the measles vaccine has saved 15.6 millions lives. But there is no antiviral treatment for those who get sick and for every 1000 child with measles one will die.

The adversity of the measles outbreak has lead parents and doctors to urge «social responsibility» i.e. «get your kids vaccinated!». NPR featured an interview the a father of Rhett, a 6 year old boy now recovering from leukemia. Due to his cancer treatment Rhett is at a higher risk for infectious diseases than his classmates. Unfortunately he lives in one of the counties with highest rate of personal belief exemptions and Rhett’s school has an exempt rate of 7 %, compared to statewide average of 2.5 %.

Cases such at Rhett’s lead to an interesting discussion on liability: if someone dies from measles, can you be held responsible for infecting them if you are not vaccinated?

The answer might be yes.

And can you be ordered into quarantine or «banned» from schools or your doctors office?

Definitely yes, several schools have ordered unvaccinated children home. These children had been exposed to measles and were told to stay at home for as long as the incubation period of the disease. Some doctors are also refusing to see unvaccinated patients as they will not risk the health of other patients. The outbreak seem to have reminded people of the importance of vaccination and opened an opportunity to restrict exemptions to only medical reasons.

In the midst of these discussion my Twitter feed was one night overrun with the hashtag #Iamtheherd: to support vaccination, to discuss vaccination and to remember a time when it wasn’t an option.

I am the herd, for myself and for you and for anyone who can’t be vaccinated.




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