Vaccine refusal, or Jenny McCarthy, better with fewer clothes on

Kaiser Permanente has released a study from its EMR database looking at use of vaccines in its Colorado region. KP in Colorado has data on about 480,000 members dating back to the mid-1990s from when they started implementing the first EMR. After that system was retired and they moved to Epic the old data is in PDF format for current records, but is also in a database for research use. I spoke to the researchers Jason Glanz & Ted Palen from the KP Colorado Institute for Health Research late last week.

Essentially the problem is that several studies have shown vaccines to be safe but some parents are really concerned, prompted in large part by certain celebrities (with former Playboy model Jenny McCarthy being among the most vociferous claiming that vaccines cause autism), and partly because they don't believe the diseases the vaccine prevents are serious.

The prevalence of whooping cough is not huge. In 2007 CDC estimated there were about 10,400 cases in US, with an average of 800 per year in Colorado. The school exemption rate for vaccination is 1–2% which is a proxy for refusals. The rate of refusal for KP members is less than 1% (which may be just missing one dose of one vaccine from the EMR data). The rough estimate of whooping cough is 20 cases per 100,000 per year. KP’s rate in Colorado is estimated at 40 per year—but the real rate is much more as only an estimated 10% of actual cases are reported.

Whooping cough, defined as a cough lasting more than 14 days (including incessant coughing & vomiting) can be very serious and can be cause of hospitalizations and death in young children. In 1930’s & 40s it had a 10% mortality rate, although now it’s only about 1%. So for now it’s not such a big deal but the concern is that numbers will go up overall, and increasingly more kids won’t be protected. The vaccination rates need to be well above 90% plus to be effective for the community as a whole.

The KP researchers identified the cases of kids with whooping cough, selected a parallel group who didn't have the condition, and looked into the record to see who had vaccinations. There were 156 cases over 12 years. In that population, 18 had refused the vaccine, which means that the unvaccinated were 23 times more likely than those fully vaccinated. 1 per 20 ‘refusers’ got the disease versus 1 per 500 vaccinated kids.

As a side-bar, this type of study is one coming out not just from the electronic records at KP, but also from an alliance of 16 HMOs are in a virtual data warehouse which has records on 15 million people (in US and in Israel). That data can be queried for different projects. A series of other studies are now being done including looking at cancer, heart disease, drug safety, vaccine safety, plus consortium studies for looking at rare diseases. Glanz said that the trend is to collaborate over these and to combine this clinical data with genetics research.

So expect much more information on the impact of real time health care using these massive databases, and let’s hope that these data drive decisions. Of course in a world in which there’s massive disagreement over the science from people like Jenny McCarthy, it may not make all the difference we could hope for.

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5 replies »

  1. We live in a culture that is increasingly suspicious of the intentions of the medical establishment. Of course the omnipresence of “infotainment” that was birthed by cable TV and reared to maturity by the internet has only aided and abetted that suspicion. Sensationalism sells and stories about declines in disease prevalence just aren’t sexy enough. Unlike Jenny McCarthy… See my recent blog for more ranting in the same vein

  2. What I see here is a plethora of people parroting what they have been told by doctors, government officials and mainstream news media (all PAID for their opinions on vaccinations, btw). The fact of the matter is that whooping cough is on the rise in our 95-98% immunized childhood population, even the CDC concedes to this fact and has stated they do not know the reasoning for this. How on earth are vaccines effective if that’s the case? Most people’s reasoning for buying into vaccinations is that they “eradicated” Polio, another fallacy- Polio only went away on paper. It was reclassified as Viral or Aseptic Meningitis or Coxsackie Virus in 1955, the year of the introduction of the first Polio vaccine. People really need to do their research! Vaccinations have never eradicated any known diseases, they fail to prevent disease now, and they are extremely dangerous (some illnesses they ADMIT to causing on the product insert: asthma and juvenile diabetes, the number one and two killers of the pediatric population in the US, permanent brain damage, other “neurological disorders”, autoimmune diseases, encephalopathy and encephalitis, anaphylaxis, and many MANY more, including DEATH)… Some may say that the risk of the diseases is worth taking the risk of the vaccine but those folks ought to consider vaccines track record at preventing disease for one (total fail!), and for two that we recommend 20 more doses than every other westernized nation on earth for birth through five and we rank 37th in the world for health and our infant mortality sucks! These are not coincidences, people. Educate before you vaccinate, and you probably WON’T!

  3. Great point, John – pertussis immunity does wane over the years, so adults (or even teenagers) who may be around a newborn should get Tdap vaccine before the baby arrives.
    (Tdap = booster for adults against tetanus, diphtheria, and pertussis. You probably need a tetanus booster anyway, so might as well get protected against pertussis at the same time. You could save a baby’s life.)

  4. Yesterday’s Morning Edition (NPR) carried the same story and included a good observation not mentioned here. Whooping cough may not be “serious” in terms of mortality, but a close analysis of the data revealed 23 deaths in infants under two months old. The report said that vaccinations are not administered until infants are old enough to develop antibodies, so vaccinating them too early has the effect of weakening the immune system instead of protecting them against the targeted diseases.
    The concept of “cocooning” was mentioned, referring to making sure that newborns are surrounded by people who have been vaccinated and will not therefore expose the babies to the disease. This underscores the point above that “good citizens vaccinate, not only for themselves, but also for the community,” especially newborns.

  5. I thought the other part of this article was that contrary to the argument of refusers that not vaccinating doesn’t hurt anyone else, it showed that a portion of total cases among vaccinated children could be attributed to those who weren’t vaccinated at all because the vaccination is not 100% effective and may diminish over time.
    The ‘herd effect’ is diminished by those who opt out. The irony being that those who opt out are not idiots but the educated who think they can ride on the general effects while dodging any potential negative effects (which are not proven) for their families.
    It doesn’t seem like you need a Ph.d to figure out that good citizens vaccinate, not only for themselves, but also for the community.