prisoner of the flesh's dilemma

[vito_excalibur]

So jedusor posted about vaccinations and I was thinking about them.

Okay, let's take a look at just one set. Let's look at the MMR vaccine. That's measles, mumps, and rubella.

If you give your kid the MMR vaccine, they have less than a one in a million chance of getting seriously ill or dying (encephalitis). Call it one in a million.

If your kid gets

Comments

[dr_memory]

Not strictly relevant to the MMR vaccine, but simply a bit of awesome visualization on a similar issue:

http://www.informationisbeautiful.net/2009/how-safe-is-the-hpv-vaccine/

[vito_excalibur]

That is beautiful! God, I love visual communicators.

...she says, having just produced a wall of text.

[shoutingboy]

It's a tough question. On top of which, there's the prisoner's-dilemma element. Perhaps if I don't vaccinate my kid, I've somewhat improved my kids' odds--but I've infinitesimally worsened the odds of lots of other people in the local population, by lowering overall herd immunity. If herd immunity is very strong, the net utility change will be positive, but at some point that stops being true--and all along, you're buying your kids' improved odds with the peril of others. (Some of those other people will be people who made the same bet you did, so fair's fair. But some of them will be people who, for health reasons, can't be vaccinated, so they're counting on herd immunity. And some of them, I assume, are people who were vaccinated but the vaccination didn't take--and a lot of vaccinations also weaken over time, so people who were vaccinated a long time ago are more at risk. Neither of those matter if herd immunity is strong, but, well, yeah

[iridium]

On only a moment before sleeping, but to that last question -- it's possible/probably that the health risks of being vaccinated are less as you get older. But the reason we vaccinate in childhood (for MMR & HiB especially; others I'd have to look up) is that these are diseases that you're much much more likely to get when you're young. Vaccines only work if you get them *before* an infection.

[fanw]

I would say that killed vaccines are safe pretty much at any age, and live-attenuated requires a functional immune system. It takes a baby about 6months to get their immune system going and at very old ages you lose immune function, but otherwise age has much less to do with safety than other factors such as AIDS, pregnancy, and other immune compromising factors.

[iridium]

This is true! So far as I'm aware, live-attenuated vaccines aren't given to children <6mos, or to other people with compromised immune systems.

(Though it might be more accurate to say that all vaccines require a (reasonably) functional immune system; if important pieces don't work, then you have to go with antibiotics and other prophylactics. A live-attenuated vax has a higher risk of becoming pathogenic if you're immunocompromised. On the upside, the live vax also is better at getting your immune system to produce antibodies that hang out on your mucous membranes, which means that 1)you're less likely to *get* an infection and 2)you're less likely to be an asymptomatic carrier.
...Er. Sorry for rambling. I'm a med student and a bit geeky about these things.)

[denelian]

so... we covered this in Foresic Anthropology [yeah, it seems sort of weird. and it was part of a lecture on determining cause of death that is specifically from a disease, as opposed to "dying from thirst/starvation" or "dying of a heart attack" etc

[vito_excalibur]

I have friends who are anti-vaccine. You don't have to respect their opinions, but you do have to respect them. Your facts are fine, but be aware that you're calling people stupid to their faces; do it again and I'll delete your comment.

[denelian]

i'm sorry; you are correct. i was -meaning- not that the people were stupid, but that the idea was. i did NOT mean to say that i thought people were stupid. it came out that way, i see that it did. i am very sorry. if you want to delete it, i will understand. [i am not *asking* you to. that's a little too close to trying to pretend i never messed up. i messed up.]

also: thank you for pointing it out. i obviously need to do more work on NOT doing this :(

i apologize again :( and i WILL work harder on this.

[vito_excalibur]

Thanks for being cool about it. :) I didn't want to delete it because, like I said, your info is good!

[angelbob]

Hard to say. While there's some good math on this -- percolation theory being a good example -- you first have to calculate the chance of disease spreading to an adjacent person (for some definition of adjacent), and the distribution of adjacent people (ditto

[vito_excalibur]

Eh, those studies also looked at pre-vaccine levels of infection in places like Scotland. Does that count as a developing country?

But yes, of course, wildly varying levels and as with everything, money helps hugely. I simplified down to a level that was easily comprehensible to me.

[morgandawn]

that reminds me of the polio case I read about where a young college student went to mexico and caught it. she had never been vaccinated and no one thought to remind her and have her get the vaccine. in fact everyone had forgotten they had skipped the vaccine.

what I told my Wisconsin relatives is: do you work with people who travel to Mexico or Asia? do you eat at places with where there are workers who have relatives who travel to mexico or asia (of course they do - many of the service jobs in Wisconsin are staffed by immigrants). they shouldn't be relying on geography to insulate them - if they want to skip vaccinations, focus on the risk of death/disablity + transmissionm method. Ex: low risk of death/disablity + harder to transmit. Top of the list of important vaccines to get when young: tetanus and polio and MMR. Lower: chicken pox.

[wiredferret]

The polio thing literally makes me cry. We were so close. SO FUCKING CLOSE to eradication, and then some culturally insenstive dorks collided with some vaccine-conspiracy nutjobs (not here, in Africa, but the effect is the same), and now it's at least another 10 years out. But it's possible. We could do to polio what we did to smallpox.

--someone who grew up at a hospital with a polio wing

[rachelmanija]

If you, like me, enjoy reading old American childrens' books, you will notice something that occurs often which almost never shows up in current ones: the death of children due to certain diseases.

I'm not only thinking of Beth in Little Women, who died of scarlet fever. (Google informs me that while there is a vaccine, antibiotics were more significant in the fact that people rarely die of this now.) In the Betsy-Tacy books, very young siblings die and life goes on; it's treated as a natural part of life, that children die of disease. In modern American novels, the death of a child by communicable disease would be the subject of the book

[redbird]

Even in more cheerful ones, like All-of-a-Kind Family, where all the children live and basically in good health, there is a case of scarlet fever, and quarantine for that; evacuating to the seaside for polio; and a family friend crippled by that polio epidemic.

[kcatalyst]

Years ago on some pregnancy newsgroup, one of the posters was commenting on the fact that there's a special word in English for a child who had lost its parents, but not one for a parent whose child had died. Her analysis (no, really!) was that this situation was so terrible to contemplate that English simply couldn't bring itself to name it.

[vito_excalibur]

....wow.

Medical establishment, 1. Sense of history, 0.