CDC eyes air travel in mumps epidemic

The fact that 68% of people that had acquired mumps had 2 vaccinations isn't exactly a good commercial for the vaccine.

As far as Chiropractic the most common stance is to have parents be informed that you have a choice to vaccinate your children. I personally don't see any thing wrong with someone that is sensitive or has a history of reactions to vaccinations to skip a vaccination which could adversely affect their personal health for the health of the masses. This is even more important when the vaccination doesn't work that great and the disease is most likely non life threatening in the majority of people that acquire the disease. "Mumps is an acute viral infection characterized by fever and nonsuppurative swelling of the salivary glands; an estimated 20%--30% of cases are asymptomatic."

http://www.webmd.com/content/article/120/113902.htm

"Iowa's public health department reports that the vaccination records of 163 mumps patients have been investigated.

Of those patients, more than two-thirds (68%) had gotten two doses of the MMR vaccine, 13% had gotten one dose, 5% had gotten no doses, and 15% had uncertain vaccine status, states the CDC.

In 1977, Iowa required one dose of the MMR vaccine for all children entering public schools. That requirement rose to two doses in 1991.

"Mumps should not be ruled out in someone who is vaccinated if they have symptoms clinically consistent with mumps," Iowa public health officials wrote in their letter to the state's health care facilities."

The fact that 68% of people that had acquired mumps had 2 vaccinations isn't exactly a good commercial for the vaccine.

The latter doesn't follow from the former and reflects, at best, ignorance of statistics. To draw any conclusions on how well the the vaccine is working in the current epidemic you need to know not only how many of the people who got the mumps had been twice vaccinated but also how many of the people who were exposed to the mumps, at thus at risk for it, had been twice vaccinated. If nearly all at risk had been vaccinated the mumps could be 100% contagious in the non-vaccinated and only 1% contagious in the twice vaccinated and still end up with 68% of the infected had been twice vaccinated. I'd consider that a darn good vaccine. My understanding is the mumps vaccine has been 85-90% protective, which is pretty good considering that there is no specific treatment if you get mumps. Yes mumps tend to be relatively mild in children, but most of these cases are young adults. Iowa has been lucky enough to have no deaths yet, but several have been hospitalized and death can occur. Besides even if your life weren't at risk how would you like your family jewels inflated for a week or so? And then have to worry whether there was any future family left in them?

There are some legitimate medical reasons to not be vaccinated, but very few people have them. There are people whose religious faith bars vaccination. Our first amendment gives them the right to make that choice and gives me the right to call them kooks! All the rest who refuse vaccination deserve to be tarred with the same brush as draft dodgers and antiwar protesters. They are freeloading cowards and worthy of our scorn. They are accepting the protection of the herd immunity created by the majority of us who accept the individual risks of vaccination and thus reduce the likelihood that they will ever be exposed to what in the pre-vaccine era would have been a major risk. All the while they are increasing the chance that those of us who chose to defend ourselves with the best available measures, may still be overwhelmed by an epidemic that wouldn't have been sustained had they collectively done their civic duty and joined in the collective defense.

You are full of it.

"If nearly all at risk had been vaccinated the mumps could be 100% contagious in the non-vaccinated and only 1% contagious in the twice vaccinated and still end up with 68% of the infected had been twice vaccinated."

There is no way to test who has been exposed and who hasn't. The silly postulate you put forward is only useful in a statistics lab, therefore what you said was ridiculous. Sure the mathematics of it works but it explains nothing in the real world.

They test a local population under the assumption that the exposure is more or less uniform. Sure, it's a lousy way to do it but that's the best they can do -- unless there is a sheltered population, like some Amish communities.

" My understanding is the mumps vaccine has been 85-90% protective"

How do you think they came up with that 85-90% number? Duh. The same way they came up with the 68% number they are using now, from a local population study.

I'm physiologically-sensitive to that kind of stuff, having had terrible asmtha as a child. Three-quarters of the way into a 7-8 hour flight I'm ready to die. And the problem has become worse in the past ten years or so. I dread flying for this reason alone. I also wonder how many air-rage incidents are aggravated by this kind of stuff.

It appears my "at best, ignorance of statistics" may have been optimistic. You wrote, "The fact that 68% of people that had acquired mumps had 2 vaccinations isn't exactly a good commercial for the vaccine" which logically meant you thought that the "68%" implied that the vaccine didn't work very well, i.e. that if you had been vaccinated 2 times and were exposed to the disease there still was a risk you'd get mumps not much better than the risk for those who'd never been vaccinated. That is not the only possible conclusion. That 68% could also have occurred if the vaccine gave significant protection and was used by most of the at risk population. One of the questions looking at any statistical results is how many % of what are they reporting. This was 68% of the losers, those that mumped. To make a useful comparison you also need information on the winners, those exposed who didn't mump. As an imperfect first approximation you could assume that the percentage immunized of those exposed mirrored that of the percentage immunized in the state as a whole, which should be at least roughly known to the public health folks. Knowing that and the historical risk of getting mumps when exposed without vaccination you can run an analysis. I don't know those last two percents, but for the sake of argument lets assume 90% are vaccinated and the risk of getting mumps without vaccination, when exposed, is 70%. Assume 100 people get exposed:

Vaccinated?:	Yes	No	Totals	% vaccinated
Got mumps	13	7	20	65
No mumps	77	3	80	96
# exposed	90	10	100	90
% mumped	14	70
% 'protected'	86	30

I don't think my only numerical assumptions, the vaccine protects 86%, 90% got it and without it 70% of those exposed got mumps are unreasonable. With chicken pox the later number would be about 95%. Yet it gave for the % of those who mumped who were vaccinated as 65%, nearly the 68% you'd cited. You wrote, "Sure the mathematics of it works but it explains nothing in the real world." If you do the statistics properly, the math describes the real world. Would you consider this table a good commercial for the mumps vaccine? If the intended audience were math literate, I would. If the intended audience weren't I wouldn't expect them it understand it. E.g., normally I'd assume it was good for FR, hopeless for DU.

There is no way to test who has been exposed and who hasn't. The silly postulate you put forward is only useful in a statistics lab, therefore what you said was ridiculous.

Contact tracing to determine who has been exposed is bread and butter public health work. It's done routinely for STDs, TB and other serious diseases. It is labor intensive and thus expensive so is less often done for large outbreaks of less severe disease. It could have been done in the early days of the US HIV epidemic, but was quashed by the libs. I've heard some PC AIDS experts admit now it might have worked then to limit the epidemic. The media reports it has been done, at least partially, in this mumps epidemic! Two cases flew commercially and they tried to reach all the other passengers.

How do you think they came up with that 85-90% number? Duh. The same way they came up with the 68% number they are using now, from a local population study.

Yes, a local population study with a defined population of who was at risk. To get the 68% (65 in my example table) you only need to count those who mumped and ask them whether they'd been vaccinated. But to get the 85-90% number (my 86) you needed a numerator, how many were vaccinated and mumped, and a denominator, how many were vaccinated and exposed. The latter being what you said "There is no way to test..." No denominator, no % protective number. Duh. I don't deny the numbers may be a bit fuzzy, but you have to have some kind of a number. Even how many have mumps may be a fuzzy number as the diagnoses aren't always certain. With a big enough, honest, sample the fuzz tends to cancel out the statistics become useful.

Now I breezed by a nonnumerical assumption, that the population exposed was immunized the same as the whole statewide population. Whether or not it is potentially interesting as could be why it is not. Such was the reason for my original posts on this subject. This, the largest US mumps outbreak in 5 years, might offer enough statistical power to answer the question. If there isn't sufficient statistical power available in this outbreak, something the public health folks can quickly determine, then there's no point in asking the question. Did the recommendations of Chiropractors, a group very popular and founded in this state, actually founded in my community, some of whom routinely oppose vaccination (I have no ideas of how many are 'shot' vs. 'no shot' in their advice) encourage this epidemic or not. Either may be true. The 'no shot' advice is controversial in medical circles, and given that they have two camps on it I presume it is also controversial in Chiropractic circles. The feedback, pro or con, would help all concerned.

Except when the disease arrive by "coyote" !