Not always so great

Not always so great

I like to refer to Portland (Oregon, not Maine) and its environs is the great Pacific NW. Seattle, of course, is excluded in that designation. Just need to be clear. Over the years Oregon has been a leader in environmental issues and great beer, two of the many reasons I like to live here.

Unfortunately, Oregon is also at the top of the list for unvaccinated Kindergartners. It is a sobering graphic with more than 6% of Oregonian exempt from vaccine for non-medical reasons. You can see what the rates are for your state and gloat accordingly.

And it is worse than it looks. Those 6% are not uniformly spread across the population. They are often clustered in private schools, for example Waldorf Schools, where rates of exemption can be 66%. Some counties and cities in the state are worse than others. Ashland has 25% of children exempt from at least one vaccine and oddly also has the highest autism rate in the state. Causality?

Add in those who cannot be vaccinated and those who do not respond to the vaccine and we are primed in Oregon for an epidemic from a vaccine preventable illness. We are probably at or past the 10% susceptible required for herd immunity to be effective

All it will take is a mumps or a measles case to get that party started.

What to do? Go me. The local environment, the social norms, seems key to perpetuating a lack of vaccination. norms can perpetuate depressed vaccine coverage during a vaccine scare well beyond the time when the population's baseline vaccine risk perception returns to pre-scare levels. Social norms can strongly suppress vaccine uptake despite frequent outbreaks, as observed in some small communities.

This is unlikely to be amenable to education. The pernicious influence social norms is better understood after reading Leaving the Anti-Vaccine Movement:

It’s hard to believe now how easily I bought into everything I was hearing from the anti-vaccine crowd. It seems extremely obvious now: doctors aren’t evil, scientists aren’t trying to kill your kids with toxins, and vaccine researchers aren’t just trying to scam you out of your money.

I graduated from medical school over 30 years ago. I have never seen a case of measles or diphtheria. I have seen one case each of rubella, tetanus, mumps and polio. That is about to change and I may be seeing disease I thought were of historical interest.

Points of Interest 2/19/2014

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