Archive for the ‘Childhood vaccines’ Category

If a child does not receive the measles vaccine does the child pose a risk to other children?

February 24, 2019


Photo Credit: National Vaccine Information Center

Legislators in the state of Washington are the latest to attempt to pass a law to remove exemptions for childhood vaccinations.   USA Today reported:

“Amid a measles outbreak that has sickened more than 50 people in the Pacific Northwest, Washington lawmakers heard testimony on Friday on a bill that would remove parents’ ability to claim a personal or philosophical exemption to opt their school-age children out of the combined measles, mumps and rubella vaccine. Hundreds of people opposed to the measure lined up more than an hour before the start of the hearing before the House-Health Care and Wellness Committee, many wearing stickers with the bill number, HB 1638, within a crossed out circle. . . . Most of the Washington cases are concentrated in Clark County, just north of Portland, Oregon.  The measure . . . has the support of the state medical association and Gov. Jay Inslee.  Inslee declared a state of emergency last month.”

Source: Hundreds protest against Washington state vaccine bill that would require measles shots, USA Today (Feb. 11, 2019).  Opponents testifying against the bill included Robert F. Kennedy, Jr., who questioned safety standards around vaccines.  USA Today reported:

“Four percent of Washington secondary school students have non-medical vaccine exemptions, according to the state Department of Health. Of those, 3.7 percent of the exemptions are personal, with the remainder being religious exemptions. In Clark County, 6.7 percent of kindergartners had a non-medical exemption for the 2017-18 school year, according to health officials.  Washington is among 17 states, including Oregon, that allow some type of non-medical exemption for vaccines for “personal, moral or other beliefs,” according to the National Conference of State Legislatures.”

The question arises whether the elimination of vaccine exemptions, which are currently used by only a small percentage of families, will significantly prevent the outbreak of measles.  A Harvard and Stanford-trained immunologist wrote an “Open Letter to Legislators” setting forth data to show that unvaccinated children do not pose a higher threat to the public than children who are vaccinated.  Source: Testimony Before the Vermont Senate Health & Welfare Committee (April 22, 2015).

The author of the letter was Tetyana Obukhanych, who earned her Ph.D. in Immunology from Rockefeller University.  She did laboratory research as a postdoctoral research fellow at Harvard Medical School and Stanford University School of Medicine.  Dr. Obukhanych wrote in her letter to legislators:

“It is often stated that those who choose not to vaccinate their children for reasons of conscience endanger the rest of the public, and this is the rationale behind most of the legislation to end vaccine exemptions currently being considered by federal and state legislators country-wide.  You should be aware that the nature of protection afforded by many modern vaccines — and that includes most of the vaccines recommended by the CDC for children — is not consistent with such a statement.”

Dr. Obukhanych further wrote:

“I have outlined below the recommended vaccines that cannot prevent transmission of disease either because they are not designed to prevent the transmission of infection (rather, they are intended to prevent disease symptoms), or because they are for non-communicable diseases. People who have not received the vaccines mentioned below pose no higher threat to the general public than those who have, implying that discrimination against non-immunized children in a public school setting may not be warranted.”

One study cited by Dr. Obukhanych was from Quebec, Canada.  It showed that persons who are vaccinated for measles can spread measles and can contract measles.  The study was about by a large measles epidemic took place in 2011 in Quebec.  A teacher in his 30s, who had been vaccinated for measles, returned to Canada from a trip to the Caribbean.  Public health officials concluded that the teacher’s importation of measles from the Caribbean resulted in 678 cases of measles in the teacher’s home community.  Of those persons who contracted measles, most had been vaccinated for measles. It was determined from vaccine coverage surveys in Quebec in 2006, 2008 and 2010 that by 24 months of age approximately 96 percent of children had received one dose and approximately 85 percent had received two does of measles vaccine. Source: G. De Serres, F. Markowski et al., Largest measles epidemic in North America in a decade — Quebec, Canada, 2011: contribution of susceptibility, serendipity, and superspreading events, J Infect Dis 207:990-98 (March 15, 2013).

Dr. Obukhanych stated that outbreaks of measles cannot be entirely prevented even if there is near perfect vaccination compliance.

Richard Pan, M.D., MPH, a state senator in California, is a proponent of eliminating exemptions for vaccines.  TIME Magazine called Dr. Pan a “hero” who authored “landmark legislation to abolish non-medical exemptions to legally required vaccines to school students, thereby restoring community immunity from preventable contagions.”

On April 12, 2017, a report by Dr. Pan stated:

“The results posted today by CDPH [California Department of Public Health] show that the proportion of kindergarten students who received the required vaccines dramatically rose from 93 percent during the 2015-16 school year, to 96 percent during the 2016-17 school year, a rate above the 94 percent rate needed to prevent measles transmission.”

One must immediately question whether an increase from 93 percent to 96 percent is actually a dramatic increase.

F. Edward Yazbak, M.D., who practiced pediatrics and was a school physician in Northern Rhode Island for 34 years, is a nationally recognized expert on childhood vaccines. He was formerly the Assistant Clinical Director of the Charles V. Chapin Hospital, a specialized infectious disease hospital, and Director of Pediatrics at Woonsocket Hospital in Rhode Island.  Dr. Yazbak suggested that vaccinating some foreign travelers would be more effective to contain measles infections than abolishing exemptions for school students. Discussing Dr. Pan’s work, Dr. Yazbak stated:

“Without mentioning measles by name, Dr. Pan appeared to suggest that the 2014-15 measles outbreak in California was somehow related to philosophical exemptions and poor pediatric among KG [kindergarten] students necessitating the introduction of SB 277.  Once more he had jousted against another windmill.”

Source: F. Edward Yazbak, Fighting Windmills in California (May 30, 2017).

(Accessed at:

Dr. Yazbak cited an “Original Research” report: E. Hyle, S. Rao et al., Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations, Annals of Internal Medicine of the American College of Physicians (May 16, 2017).  Dr. Yazbak noted: “The authors of the ‘Original Research’ report, all attached to distinguished hospital and universities, clearly stated that: ‘Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers’ and not to foreign visitors or a magic percentage of California or US children.”

(Emphasis added.) Dr. Yazbak noted that the research report concluded: “Of U.S. adults travelers who presented for pretravel consultation . . . 16% met criteria for MMR vaccination according to the provider’s assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of importation and transmission of measles virus.”

Dr. Yazbak noted that Annals of Internal Medicine has been called: “Among the five most widely cited medical journals in the world [and] sets the standard for evidence-based, practice relevant information.”


Dr. Yazbak also noted that the E. Hyde, S. Rao et al. research report was accompanied by an editorial by Lori K. Handy, M.D., and Paul A. Offit, M.D.: Why Aren’t International Travelers Vaccinated for Measles?, Annals of Internal Medicine (May 16, 2017). Dr. Handy is an Assistant Professor of Pediatrics at Sidney Kimmel Medical College, Thomas Jefferson University.  Dr. Offit is Professor of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia.

Dr. Yazbak noted that Dr. Handy and Dr. Offit reported in their editorial:

“Before a vaccine against measles was introduced, 500,000 cases occurred each year in the United States, resulting in 500 deaths, 48,000 hospitalizations, and 1,000 cases of permanent brain damage from encephalitis.  Endemic measles was eliminated in the United States in 2000, but sporadic outbreaks have occurred since then because of importation of the virus from other countries.  In 2014, the United States had the largest single outbreak of measles (667 cases) in more than 20 years because of infected travelers returning from abroad combined with the low vaccination rate of certain U.S. populations.  This outbreak was linked to travel to the Philippines, which was in the midst of a measles epidemic.  In 2015, a multistate outbreak associated with Disneyland was the result of a park visitor who had traveled overseas. 188 cases were reported that year. Importations remain the source of measles transmission in the United States, and persons visiting travel clinics present an opportunity to reduce or eliminate these cases.”

(Emphasis added.)  Dr. Yazbak stated that Dr. Handy and Dr. Offit “clearly were not talking about KG vaccination rates.”  Dr. Yazbak added:

“The related Editorial by Handy and Offit should make reasonable people wonder whether Dr. Pan’s elation was justified and whether indeed a 1 or 2 % increase in vaccination in Kindergarten was going to actually prevent infectious disease outbreaks and as Dr. Pan promised ‘restore community immunity throughout our state in the coming years.'”

Dr. Yazbak concluded:

“Like everywhere else, there are a multitude of serious issues confronting California.  The relatively small number of pediatric vaccination exemptions does not appear to be the state’s gravest challenge.  Maybe Senator Pan can forget the windmills and concentrate on discovering what is really causing California Mega-Epidemic of Autism.”


Photo Credit: Alliance for Human Research Protection