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posted by takyon on Saturday July 04 2015, @11:30PM   Printer-friendly
from the jenny-mckillthy dept.

Health officials on Thursday confirmed the country's first measles death since 2003, and they believe the victim was most likely exposed to the virus in a health facility in Washington state during an outbreak there. The woman died in the spring; a later autopsy confirmed that she had an undetected measles infection, the Washington State Department of Health said in a statement. The official cause of death was announced as "pneumonia due to measles."

According to the U.S. Centers for Disease Control and Prevention, 178 people from 24 states and the District were reported to have measles from Jan. 1 through June 26 of this year. Two-thirds of the cases, the CDC noted, were "part of a large multi-state outbreak linked to an amusement park in California."

Measles were effectively eliminated in the United States in 2000, according to the CDC. Health officials have said that the disease made a comeback recently, in part because of a growing number of adults deciding to delay or abstain from vaccinating their children. Last year brought the highest number of recorded measles cases since 2000, according to the CDC. Earlier this year, President Obama acknowledged the concerns some have about effects of vaccines but said: "The science is pretty indisputable." "You should get your kids vaccinated — it's good for them," Obama said. "We should be able to get back to the point where measles effectively is not existing in this country."

takyon: Celebrity critics recently denounced California's new mandatory vaccine law.


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  • (Score: 1) by khallow on Sunday July 05 2015, @12:28AM

    by khallow (3766) Subscriber Badge on Sunday July 05 2015, @12:28AM (#205154) Journal

    If they do not eradicate it (and this will be difficult because it can remain active for hours in dry air), there will be a gigantic measles epidemic eventually.

    Not if the population which isn't immune doesn't concentrate in one place.

  • (Score: 4, Interesting) by Anonymous Coward on Sunday July 05 2015, @12:58AM

    by Anonymous Coward on Sunday July 05 2015, @12:58AM (#205163)

    It is true the exposure depends upon the susceptibles being in the same location, but they do not have to be there at the same time.

    Someone with measles can cough, sneeze, or breath in a room which exposes anyone who enters that room to the virus, even after they are long gone.[1] How long the air is contaminated depends upon the indoor relative humidity[2] and ventilation[3]. A measles virus can survive for hours in a poorly ventilated room during the winter (low indoor humidity).

    If 15% (1/6) of the population is susceptible (and that is optimistically assuming zero waning immunity) the virus will easily spread via supermarkets, office buildings, etc. This is true even if they are uniformly distributed geographically. That is why the CDC makes such a giant deal out of quarantining any measles cases. If a critical number of cases is ever reached, there will be a gigantic one time epidemic dwarfing anything ever seen. Paradoxically, this last gasp will probably result in measles eradicating itself. There will not be sufficient susceptibles remaining to sustain transmission.

    And honestly, the effect of anti-vaxxers on this has to be a rounding error.

    [1] http://jama.jamanetwork.com/article.aspx?articleid=397383 [jamanetwork.com]
    [2] http://link.springer.com/article/10.1007%2FBF01253797 [springer.com]
    [3] http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.38.6.775 [aphapublications.org]

    • (Score: 2, Interesting) by Anonymous Coward on Sunday July 05 2015, @02:09AM

      by Anonymous Coward on Sunday July 05 2015, @02:09AM (#205173)

      Same AC. According to the CDC the percent of children receiving zero vaccinations (as would be expected for anti-vaxxers) is under 1, a rounding error.

      less than 1% of children had not received any vaccinations
       

      http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm [cdc.gov]

      So this focus on anti-vaxxers is misguided. Who are these other 10% of unvaccinated? Poverty?

      • (Score: 2) by frojack on Sunday July 05 2015, @05:38AM

        by frojack (1554) on Sunday July 05 2015, @05:38AM (#205202) Journal

        Not the way I read it.....

        This report describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010–May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target* for ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%);

        Then there is this:

        NIS is a random-digit–dialed cellular§ and landline telephone survey of households with children aged 19–35 months in the 50 states,

        So when a Government Agent calls an Anti-vaxer, and asks if their kids have all their shots, what do you spoze they say....?

        It should be patently obvious that there would never have been an outbreak of measles at Disneyland if there was 99% coverage of the entire population.

        --
        No, you are mistaken. I've always had this sig.
        • (Score: 1, Funny) by Anonymous Coward on Sunday July 05 2015, @06:14AM

          by Anonymous Coward on Sunday July 05 2015, @06:14AM (#205208)

          You think anti-vaxxers make up at least 10% of the US population, and further that we have no idea what percent of people are actually vaccinated for measles but 90% is an overestimate?

          Possible, and very, very important if true. Do you have any supporting evidence for this?

          • (Score: 2) by frojack on Sunday July 05 2015, @06:53AM

            by frojack (1554) on Sunday July 05 2015, @06:53AM (#205218) Journal

            Using the same source as the AC I was responding to. Exact same link.

            --
            No, you are mistaken. I've always had this sig.
            • (Score: 0) by Anonymous Coward on Sunday July 05 2015, @08:33AM

              by Anonymous Coward on Sunday July 05 2015, @08:33AM (#205228)

              That was me, the same AC. I'm not sure why I got modded funny. That makes the problem I brought up even worse. Do you know of any additional evidence that these polls the CDC is basing their decisions on are inaccurate. I have read that this data was inaccurate in the past, but thought they resolved that by now:

              Over 20 years of national immunization coverage rates (1959–1985) were estimated from information that was not verified. Coverage rates from the last several years of this time frame are known to be inaccurate, and it is probable that the rates from earlier years are also inaccurate. While these data are sometimes useful to provide historical perspective to national vaccination delivery efforts, their known inaccuracies must be acknowledged. Also to be acknowledged and avoided is the temptation to graph and assess coverage over time using data from different surveys.

              http://www.sciencedirect.com/science/article/pii/S0749379701002860 [sciencedirect.com]

              You seem to be saying we still have no idea what percent of people are vaccinated, but we should take the phone survey results as an upper bound.

              • (Score: 2) by frojack on Sunday July 05 2015, @04:55PM

                by frojack (1554) on Sunday July 05 2015, @04:55PM (#205315) Journal

                I'm saying phone survey data can't be trusted at all.

                You claimed only 1 percent were unvaccinated, and posted a link to back it up.

                I was merely pointing out that YOUR OWN LINK says 90 only percent were vaccinated. (which doesn't even achieve herd immunity).

                I copied and pasted from your own link.

                You should maybe read links you post. And maybe stop posting as AC if you expect to carry on conversations.

                --
                No, you are mistaken. I've always had this sig.
                • (Score: 0) by Anonymous Coward on Sunday July 05 2015, @11:15PM

                  by Anonymous Coward on Sunday July 05 2015, @11:15PM (#205400)

                  Perhaps we have a miscommunication. The CDC link said that ~90% of children received measles vaccinations, but over 99% received at least one vaccine. Since anti-vaxxers are against all vaccines, that indicated to me that anti-vaxxers are only a small minority of the 10% of children not vaccinated for measles.

                  You also pointed out that it is a phone survey, which "can't be trusted at all" and gave reasons that the survey would overestimate the percent of people vaccinated against measles. I agree, phone survey data is dubious and should not be used to influence public health policy, at least in the absence of supporting evidence.

                  If the only data available is the phone survey, it would appear we have no idea what percent of people are vaccinated. I'm not sure you realize how important that is.

    • (Score: 2) by MichaelDavidCrawford on Sunday July 05 2015, @02:42AM

      Spend some time in oldtown Portland. Which would work best, to renovate the ventilation or to vaccinate the residents?

      I personally am far more concerned about dying in an electrical fire because I cannot escape than I am about catching measles.

      --
      Yes I Have No Bananas. [gofundme.com]
      • (Score: 0) by Anonymous Coward on Sunday July 05 2015, @08:40AM

        by Anonymous Coward on Sunday July 05 2015, @08:40AM (#205231)

        Which would work best, to renovate the ventilation or to vaccinate the residents?

        I don't know. I could come with a model showing either way is superior with the right assumptions. We need data to constrain it.

        • (Score: 1, Offtopic) by MichaelDavidCrawford on Sunday July 05 2015, @11:25AM

          what that means is that if the City of Portland were to enforce electrical, fire or building codes, they would be tied up in court for twenty years.

          Ron Jeremy's Club Sesso just outside downtown portland just shut down because they stand accused of bribing a fire marshall. I have no opinion either way however I was once a member; it was plainly apparent that it has grossly inadequate fire escapes.

          The Backspace Cafe on Fifth and Couch shut down a few months after I pointed out all of its electrical faults to the baristas, then wrote a detailed, eight-page explanation of what a ground fault tester is, how to use it as well as why one should use it. I gave it to a barista then said "Give this to your owner".

          I am dead certain that either backspace's owner, or the building's owner was bribing the fire marshall as well; the barista protested that they had monthly fire marshall inspections. I expect the fire marshall did turn up once a month, but if I did he never looked at any of the many quite severe electrical hazards.

          There is a hallway in a certain building in Portland in which one can be locked in. There is no escape if you find yourself in that hall after close of business. However there is a blue "fire alarm", with instructions to pull it to unlock the door, in event of fire.

          So you are a child and cannot read. You are a foreigner as is common in portland and you don't read english. You are blind. The hall is filled with smoke.

          Oh I know, I'll read the fine manual! That will save me from dieing in a fire!

          --
          Yes I Have No Bananas. [gofundme.com]
          • (Score: 0) by Anonymous Coward on Sunday July 05 2015, @12:30PM

            by Anonymous Coward on Sunday July 05 2015, @12:30PM (#205270)

            That type of petty conspiracy shit is why it so hard to model this type of thing. So you agree then, noone can know the correct approach for a given area. I imagine it is even more complex in certain places outside the US.

    • (Score: 1) by khallow on Sunday July 05 2015, @02:48PM

      by khallow (3766) Subscriber Badge on Sunday July 05 2015, @02:48PM (#205291) Journal

      It is true the exposure depends upon the susceptibles being in the same location, but they do not have to be there at the same time.

      Hours is not a significant length of time. And the problem is that you don't have a population mostly of susceptibles. If it really were that easy to spread measles in a vaccinated population, we would have had those epidemics already.

      And honestly, the effect of anti-vaxxers on this has to be a rounding error.

      Not at all. As long as the population of unimmunized is sparse and poorly connected, it's not an issue. But if you have a well connected population, even one that is small part of a larger population, then you have the means to spread measles throughout a larger population that has partial immunity.

      • (Score: 0) by Anonymous Coward on Sunday July 05 2015, @11:26PM

        by Anonymous Coward on Sunday July 05 2015, @11:26PM (#205403)

        You seem to be assuming that measles spreads primarily via direct contact. That is what they assumed in the 1960s, but it is not true. Measles is airborne and that makes the herd immunity concept much more complex. Here is a retrospective (from 1980) by the head of the CDC during the introduction of the measles vaccine explaining why that idea is in error:

        Although the concepts of epidemic theory can be generalized without limit, the mathematical expressions of the theory had to be extremely simplified in order to be workable for the average student. A key assumption was that contagious diseases were spread by contact, that the contact rate of each case or
        carrier was reasonably constant under any given set of conditions, and that the major factors leading to variation in epidemic patterns were determined by environmental circumstances, particularly crowding, and by the proportion of susceptibles in the population. The studies of Chapin and many others of the high
        secondary attack rates among susceptible household contacts of many contagious diseases, particularly measles, supported these views. The Epidemic Theory, as
        expounded in the 1930s and 40s. left no room for airborne infection and ignored the concept of the occurrence of the occasional dangerous carrier or "superspreader" that is now clearly recognized in many diseases.

        http://www.ncbi.nlm.nih.gov/pubmed/?term=6939399 [nih.gov]

        • (Score: 1) by khallow on Monday July 06 2015, @02:19AM

          by khallow (3766) Subscriber Badge on Monday July 06 2015, @02:19AM (#205452) Journal

          You seem to be assuming that measles spreads primarily via direct contact. That is what they assumed in the 1960s, but it is not true. Measles is airborne and that makes the herd immunity concept much more complex.

          No, I believe that distinction is wholly irrelevant. For example, the two phenomena mentioned, air-borne contact and the somewhat higher number of contacts, "superspreader" don't actually change the model. You still have to be in near proximity to an infected person in order to catch the disease yourself.

          But even if the contact model were somehow in enough error to be irrelevant as a model of the spread of measles, it still is irrelevant to our discussion. Herd immunity is not a consequence of physical contact-only models. It is instead a consequence of the physical reality and backed by decades of observation of measles and other diseases. And the obvious here is that measles has had plenty of opportunity to become a "gigantic epidemic" since vaccination and instead it has nearly vanished despite plenty of reseeding from places that still have measles.

          • (Score: 0) by Anonymous Coward on Monday July 06 2015, @02:48AM

            by Anonymous Coward on Monday July 06 2015, @02:48AM (#205458)

            You are incorrect . The R0 values are used to calculate the percent of the population to be vaccinated for eradication (1/R0). RO depends crucially on the effective contact rate, which, as explained by Langmuir, was assumed to be relatively stable from person to person and day to day. Applying these models to a situation where one person may expose thousands of others in an hour will be misleading. Read the paper, Langmuir explains how *he* made this error in the 1960s when predicting the effectiveness of measles vaccination.

            https://en.m.wikipedia.org/wiki/Basic_reproduction_number [wikipedia.org]

            • (Score: 1) by khallow on Monday July 06 2015, @03:07AM

              by khallow (3766) Subscriber Badge on Monday July 06 2015, @03:07AM (#205465) Journal

              You are incorrect .

              Then where's the argument that I'm wrong? It's not important that contact rate is relatively stable as long as the collective R0 rate is below 1. For example, suppose we consider the case of the one person who infects thousands. As a result, due to 15% immunity rate, only a few hundred will actually show symptoms of measles. In turn, these people will be considerably less infectious than the first person (since superspreaders are by historical observation rare) and infect maybe a few hundred more by the time the bout of infection peters out a few weeks or months later. Your gigantic epidemic causes perhaps a few thousand people in the worst case to show the symptoms of measles.

              • (Score: 0) by Anonymous Coward on Monday July 06 2015, @05:41AM

                by Anonymous Coward on Monday July 06 2015, @05:41AM (#205498)

                as long as the collective R0 rate is below 1

                It is not R0 that directly matters but the effective reproductive rate R=R0*S/N, where S=# Susceptibles and N=Total Population. When R is less than 1 but the disease is not eradicated, S will constantly increase. "Superspreading" is not (only) a property of the person, but the environment and population. Note that these calculations assume a homogeneously mixing population which may or may not be a good enough approximation of reality.

                The second scenario represents the impact of a vaccination programme that reaches high levels of coverage (85% of all new-borns) which are, nevertheless, not high enough to lead to eradication of the agent. However, for the first 15 years after the introduction of vaccination, it appears as if eradication has been achieved, there are no infections. Then, suddenly, a new epidemic appears as if from nowhere. This is an illustration of a phenomenon known as the ‘honeymoon period’. This is the period of very low incidence that immediately follows the introduction of a non-eradicating mass vaccination policy. This happens because susceptible individuals accumulate much more slowly in a vaccinated community. Such patterns were predicted using mathematical models in the 1980s6 and have since been observed in communities in Asia, Africa and South America7. Honeymoon periods are only predicted to occur when the newly introduced vaccination programme has coverage close to the eradication threshold.

                http://www.ncbi.nlm.nih.gov/pubmed/12176860 [nih.gov]

      • (Score: 0) by Anonymous Coward on Monday July 06 2015, @12:55AM

        by Anonymous Coward on Monday July 06 2015, @12:55AM (#205435)

        If it really were that easy to spread measles in a vaccinated population, we would have had those epidemics already.

        I agree, this is surprising. Along those lines, it is interesting that this woman was asymptomatic. How many people *are* getting measles?

        Perhaps the classic symptoms only occur in 10-20% of the population. That would explain a lot actually. Before the vaccine they thought they were only recording ~17% of the US cases, currently ~15% of US people react to the vaccine with a rash and fever... I wonder if there is a haplotype related to measles infection found in 10-20% of the US population.