“boring old germ theory”

Relatively to their preferred theory, that would be “boring new germ theory”. Sorry, I couldn’t help myself.

As to the reasons why evangelicals are more likely to be sexually active at a younger age, I have to think that part of it relates to their wholesale and wholehearted adoption of patriarchal norms. Young women are groomed to be subservient and acquiescing, and young men are taught to be domineering.

Regenerus thinks, and I agree with him on this (though not on much!), that it’s in part because they’ve been groomed to find non-intercourse sexual activities to be perverse. Atheists and Jews are amongst the groups who are the oldest to have intercourse, and they tend to have sex educations that are less weighed down in sexual shame than other groups.  The less sexual shame you have, the more likely you are to open your mouth and discuss what you’re doing with a partner.  Not to be too TMI, but that was largely my experience.  I didn’t believe in any gods that were judging me, and neither did my first boyfriend, so we talked a lot about what we were going to do in bed before we did it, instead of furitively trying to hold back without discussing what you’re doing and then being tempted to go too far without protection.

Of course, to be clear, scientists have found that HPV is transmitted a lot through non-intercourse sexual contact.  In and of itself, that’s not a huge deal—-you really do have to get it on your cervix to get the cancer, from what I understand—-but what it does is makes the vaccine ineffective.  So say you get HPV 16 in your throat from oral sex when you’re 15.  You may still be a virgin, but if you get Gardasil, you get no protection against it on your cervix, so when you DO have intercourse, you’re exposed.  I mean, I may have part of that wrong, but from all the research I’ve been doing, that appears to be part of the logic for vaccinating kids early.  You want to get them before they’re even really French kissing, which a lot of 12-year-olds are beginning to experiment with.

As one of my friends, who went to a Pentacostal church, remarked to me one time:

“There’s only one reason teenagers go to church functions and activities——-and it ain’t theology, folks!”

Correction - to get cervical cancer.  I thought there was some preliminary research showing a possible link between the virus and other cancers and that the location of the infection makes a difference as to where (the throat cancer uptick I think we have discussed here before would be and example).  Not that I remember where I saw it or have time to look. 
I really dislike that a desease that can be transmitted by other means, not so vastly uncommonly as to be really unheard of, is called an STI.

For a lot of conservative Christians, disease really is a judgment from god.

Which is pretty ironic, because the only genuine moral advance occasioned by the advent of Christianity was precisely to get people to stop thinking like that, both because Jesus explicitly said that disease isn’t caused by sin, and because the whole wandering healer shtick put them in the symbolic role of helpless victims saved by the hero. All the other nice stuff in Christianity was taken directly from Judaism.

@SomeGuy:

Jesus was pretty explicit about not sentencing women to die because they had sex, so I’m thinking that conservative Christians would be in for a shock if they knew what he thought about this whole debate.

A lifetime is a long fucking time

at least if you’re doing it right!

If your child has a healthy enough immune system to be vaccinated, and you don’t vaccinate your child, you’re a bad parent.

What still bothers me is that people are acting like the HPV vaccine, which happens *gasp gosh so young* is the first time we start talking to our children about reproductive health and hygiene, which is bullshit. We have to teach little girls to wipe front-to-back (it’s actually not the ‘natural’ motion, we have to train ourselves to do it). Training a 2-year-old girl using the potty that she needs to wipe “cleaner to dirtier” doesn’t involve having to go through the whole anatomical recursion of vaginas, infections, etc. Training a little boy to carefully wash his penis (especially around the foreskin if applicable) doesn’t mean that parents have to start talking about the early warning symptoms of chlamydia, or that they’re giving him the sign-off to have sex. We have to teach children about “bad touching” and “private areas” to protect them from harm, and I know plenty of parents have to have discussions with their young children about when it is and is not appropriate to masturbate, but even if a parent is ok with their kid playing with themselves in their bedroom it doesn’t mean that they’re going out and buying their kid sex toys.

“Mommy why do I have to wipe front to back?”
“Because up front is a cleaner, more delicate area and you don’t want to be bringing things from the dirty back up there.”

“Mom, why am I getting this shot?”
“It’s a vaccination against a virus that has been known to cause a few different kinds of cancer. You’re lucky to have the opportunity, this virus is pretty common.”

I’m trying to see the difference.

When Gardasil first came out years ago, I saw a little piece about it in—-I want to say People but it was probably Newsweek—-about the vaccine and whether it should be mandated, and they profiled this woman who just laid all her womb-controlling out for all to see. She said it shouldn’t be mandated, you see, because it was a vaccine to protect against the consequences of premarital sex, and her daughters didn’t need that protection (the mother was photographed with her two girls) because they were waiting until marriage to have sex.

The whole piece was just soaked with this attitude of, “My family is so much better than yours and I don’t like this new development because it might deny me a chance to remind you of that.” I mean, she wouldn’t very well want other parents’ kids to be immunized against HPV, because then she wouldn’t know which ones were having that dirty premarital sex, and she wouldn’t be able to point to a disease to terrorize her daughters into behaving like good little self-denying followers of Jesus.

And I think that this is really what a lot of rightwingers have on their minds when they complain that the vaccine is going to turn their daughters into rampaging Slutty McSluttersons: they want there to be consequences to having unauthorized sex. If one major STI can be vaccinated against, then before you know it, we’ll have vaccines against all of them, and if we also have access to reliable contraceptives, then parents who want to frighten their kids out of seeking unauthorized orgasms will be fresh out of ammo. This illusion of control they currently have, that if you Just! Do! The right thing! that you’ll avoid the fate of those dirty sinners who can’t keep their legs together, will be rendered totally irrelevant.

”...I’m thinking that conservative Christians would be in for a shock if they knew what he thought about this whole debate.”

I’m thinking if there actually was a real historical Jesus (and he wasn’t the equivalent of Jim Jones or David Koresh back in the day) he would have been shocked to see what was already being done in his name within days/weeks after his death.  Supporting/promoting evil in the name of Jesus is a great old christian tradition.

Much as today’s Reagan-worshiping “conservatives” would cast the actual Ronald Reagan out of the party for being too liberal, too many of today’s “christians” would stone the actual Jesus to death for his heresy RE their understanding of the Old Testament and virtual rejection of the New Testament.  They only need Christ to hang around just long enough to pilfer his name, and then after that shut the hell up and go lie down in front of that Liberty University bus, you dirty hippie liberal…

I’d point out that you can lower the impact upon a population by disease with ‘proper nutrition’ and ‘seemingly arbitrary codes’.  Which to most people ‘organic foods’ and ‘not sinning’ is.

What I don’t get is that they accept religious codes as a way of avoiding mishap; but then they ignore evidence based rules to avoid mishap - or at least claim to.  If something works, it works.  It’s not like most of their religious codes aren’t reverse-authorized:  Something is icky, or the pope says x, by the way this part of their holy text authorizes it.

Also, your image is disturbing.  I’ve worked really hard to no longer just have a seizure when faced with needles; I’ve stayed awake through /most/ of my blood draws recently, but this image was so distracting I had to move the text away so I could have the image off the screen. x-x   Alas.

I’ve been thinking about this a lot lately, probably for the same reasons you have.  Two of my thoughts:

* Regarding Perry’s firm support for the vaccine: I’ve been wondering if perhaps he or his wife have had their own brush with HPV.  Obviously, I don’t judge them, having had my own brush with HPV.  His firm support resembles how I’d probably handle the issue if I was in his shoes.  Sadly I can understand why he wouldn’t come right out and say it.  “I support the HPV vaccine because I know from personal experience how much it sucks to have warts removed from your genitals” isn’t very presidential sounding.

* I think support for the mandatory vaccine at age 11 will go up in a few years.  By that time, some of daughters of these parents who didn’t get their kids vaccinated because they ‘don’t trust pharmaceutical corps’ (or whatever stupid reason that’s their cover for squeemishness at the thought of their daughters having sex) will be teenagers who are dating.  And (at least some of) those parents will have a moment of clarity where it occurs to them that their daughter might be having sex soon, and maybe should get this vaccine.  And that point they’ll realize that getting the vaccine for a teenage daughter is a lot more awkward than getting it for an 11 year old, and more closely resembles a “go-ahead” to have sex.

Troy Anthony Davis (1968-2011) has been killed by the state of Georgia.

:(

Shit. Posted the above comment in the wrong thread… sorry.

Reminds me of the Animal House scene where the sorority girl was revealed to be wearing latex gloves when giving a handy.

Science is getting from the right and the left. The right because it doesn’t always give the comfortable answers, and the left for more or less the same reason but in a different direction. It’s sad to watch. The left I grew with was always in favor of science, even if we didn’t like the answers. Sometimes you just had to listen to god.

The hepatitis vaccine is also given at 12 or so to prevent sexual transmission, but they don’t spell that out as explicity - it’s just “you don’t want your kid to get hepatitis”.  My pediatrician said they started explaining it differently, but everyone’s reaction was “my baby won’t be having premaritial sex so she won’t need it”, so they just started saying it’s to prevent hepatitis.

It does bother me that the “oh noes, sexytimes disease” is being used to say the vaccine should be given.

But I do disagree with Amanda about why some liberals, myself included, aren’t so big on throwing a vaccine or a standard medical treatment at a problem, and why some think general health and nutrition boosts our immune systems.  For *years* I was given antibiotics for my sinus infections, 10 years ago I stopped taking them because I thought they did not work.  Turns out, the do not.  In part, because many infections are viral, in part (and this is the part doctors knew all along) because it is so hard to get drugs in the sinuses through oral medication—to the point that sinus cancers are treated with radiation and never chemo because the drugs won’t get there.  Basically, by giving me those antibiotics, they screwed with my GI tract (which broad-spectrum antibiotics will always do) and didn’t do me any good, and contributed to the problem of overusing antibiotics. 

Also, regarding general health and nutrition and the immune system—I know the health problems I have had when my nutrition has been poor and my stress levels high.  I had a serious unilateral sinus condition that at least one of my doctors thinks is highly related to on the job stress.  (I left that job.)  I have known people who get hives from stress, I have gotten hives from stress.

And one of the interesting questions about HPV and cancer, and people who clear the virus and who do not—is what is different about these people?  In short, is failing to clear the HPV not just a statistically random thing, but evidence of a dysfunction of the immune system?  And just like my hives and sinus condition, could they be stress related?  And could that stress be alleviated by proper nutrition and fitness?  These are not crazy things to think.  For most illnesses, the best thing to do is rest and reduce stress.

Mighty Ponygirl,

These kind of “bad parent” statements really piss me off.  We don’t know yet how effective the vaccine is.  We don’t know how long the vaccine is effective.  We don’t yet know what kinds of adverse reactions the vaccine causes.  It has not been on the market for long.  Although cervical cancer is really, really serious, that does not mean we yet have enough data to make the vaccine mandatory, or say that people who aren’t getting it for their kids are doing the wrong thing.  Most people get and clear HPV.  These types of things are always a cost-benefit analysis.

Now, if the *only reason* a parent isn’t getting their child the vaccine is because it is a sexay sex disease, I am with you.  Most parents expect their children to have sex eventually, and, as I wish people would emphasize, tons of cases of HPV occur non-sexually.

I take issue with mandated vaccinations because of the simple fact that an individual in my opinion should be free to do with their bodies and their families as they choose.  I am close friends with some Christian Scientists and while I believe that they are nuts in their want to not vaccinate I do not agree that they should be forced to.  Many people point that there is often times an exception made to vaccinations for religious beliefs I think of my crazy paranoid relative who will not be named even by relation.  She believes that vaccinations have many unsafe side effects (I think we are all aware of the autism scare).  While I do not personally hold these views I am uncomfortable with the idea that the State should be able to tell my paranoid relatives that they have to do something that they are uncomfortable with whether I think their reasons are valid or not.

I understand the herd mentality and the idea that doctors and health care professionals are trying to look at the overall health of the community.  I truly appreciate that and I support all efforts at education and free immunizations.  I just am uncomfortable with the idea of mandates.  Not only for the infringement on personal beliefs but also for the precedent which it sets.  Once the State can mandate shots for individuals in ways which are obviously beneficial and scientifically proven who is to say that this will always be the case.  Governments are made up of people and people are inherently flawed and corruptible.  To believe that the State is always acting in the best interest of its citizenry is belied by the history of governance.  While I believe this current vaccination is probably good for the community, the individual and the family I still do not believe that it should be mandated.  Just a slightly different dissenting opinion.  On a side note…you are one of the smartest bloggers out there and I read you religiously…keep up the good work!

talmageb, one of the things doctors often don’t tell you is that vaccines don’t always work for a given individual. They are dependent upon the phenomenon of herd immunity for reliability. And herd immunity tends to break down when there are concentrated pockets of unimmunized individuals, spreading to those in the general population whose vaccine didn’t “take” (perhaps 10% or so of the vaccinated).

This is hardly theoretical. My cousin’s three-year-old, whose immunizations were all up-to-date, nonetheless came down with whooping cough. Her daughter is OK now, but it was an utterly miserable experience that she’ll remember for the rest of her life. My cousin just happens to live in a part of California where vaccination rates are low and where whooping cough outbreaks recently have become common. There have been deaths.

No one here will come into your home and demand to jab a needle in your kid’s arm. But proof of immunization is required for that child to attend public school (though there are specific exceptions). I don’t know what form the “mandate” takes in other states, but this seems quite reasonable to me. Such mandates have existed since the 1950s for polio, even earlier for smallpox—if you’re worried about precedence, well, it’s way too late.

This isn’t just about a private decision a parent is making for their child. This is a decision they are making that is endangering other children—children like my cousin’s daughter.

I know that this vax was originally targeted at girls because of the cervical cancer connection, but I’d like to see more focus on boys as well. It’s been briefly mentioned about the rising indications of the connection between HPV and throat cancers in men. I can speak to this personally as I was diagnosed with squamous cell carcinoma of the tonsils in 2008. This is a cancer that is traditionally very rare outside of heavy smokers and drinkers, and i was neither. And even if I had been I was 20 years too young. The fine oncologists who helped me were the first to tell me about the shocking rise in these cancers in (relatively) young men without any other risk factors, and how research is showing the connection between many of these cases and HPV exposure, most likely through oral sex with women.

With perfect timing, right after my diagnosis, the NYT came out with a story on it. http://www.nytimes.com/2008/05/13/health/13canc.html .

Of course, if it’s too icky to talk about girls getting HPV from just plain old sex, how much more icky would it be for some people to talk about their little boys one day growing up to go down?

I was one of the lucky ones in several respects. Surgery and radiation seem to have done the trick. Three years out+ and no sign of recurrence. It is one form that seems to be responsive to cures, but I was also lucky in that it wasn’t on the back of my tongue where it’s much harder to find and usually found only after it’s much more serious.

It’s interesting is that it’s men in their 40’s that are getting it. Something about hitting puberty in the 70’s that taught us it was not only ok, but desired (and fun!) to engage in oral sex with our female partners that’s caused the rise. Plus the rise in HPV in women at about the same time created ideal conditions for this.

My only real concern about more awareness of this is the possible consequence of creating more backlash against oral sex amongst men. It is a very tricky situation all around, a veritable nexus of neroses around sex, disease, religion (both established and the organic and yoga set, glad you mentioned them as well), “pollution” (you know how all those lady bits are so dirty and all), and denial.

I would hope, in the end, that more awareness of the risk to the “precious little boys” might make some patriarchal groups reconsider as well as make some parents of boys not feel so indifferent, as if it’s only girls who get HPV. And the larger the population who get the immunity, the better the chances of reducing rates of infection. My son is getting it. I learned the hard way. Thanks, Amanda, for being obsessed about this.

If a parent really, truly thinks that getting a child vaccinated against a form of cancer whose vector happens to be an STI is going to turn around and make the child a slut, I just don’t know how you can help those people.  I am trying to put myself in my own 12-year-old head and I am trying to imagine myself going to the doctor for a shot and then thinking “Woot!  I can fuck whomever!”  If that is really what you think your 12-year-old will think, you REALLY need to sit down with your kid.  I mean it.  And if that is the way your kid thinks, getting or not getting a vaccine isn’t going to stop hir from fucking.  I mean that too.

It’s not like HPV is the only STI around.  If you need that to “scare your kid straight,” you can always use herpes or HIV or whatnot.  And you can always just tell your kid it’s a vaccination against cancer.  You don’t have to say which one or how it’s transmitted.  I mean, Jesus.  It’s a goddamn vaccine.  Against CANCER.

Supporting/promoting evil in the name of Jesus is a great old christian tradition.

“Religion is an insult to human dignity. With or without it you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion.”
—Steven Weinberg

Vaccinations are a bit of a pit issue for me.  My uncle died relatively young (~50) from liver failure due to hepatitis, which he got from his first wife.  I don’t know if either he or his first wife ever received the hepatitis vaccine, but if we can beat polio and small pox, we can probably beat hepatitis and HPV.  I have very little patience for people like talmageb @#20.  What about my uncle’s right not to die from hepatitis?  It’s one thing if you have a medical condition that would make it dangerous for you to receive the vaccine, but it’s something else entirely to have an irrational fear of vaccination because you bought into scaremongering by religious idiots about vaccines that have been proven safe in extensive medical trials.  And if you have reason to believe that said trials are incorrect feel free to provide some evidence as to how or why.

  I am close friends with some Christian Scientists and while I believe that they are nuts in their want to not vaccinate I do not agree that they should be forced to.

It is only because of the Christian Scientist’s status as a very tiny religious minority that this is allowed by the grace of the state. If they were large enough to make an impact on the population’s overall herd immunity, they would lose the right to opt out.

I just am uncomfortable with the idea of mandates. 

Same here. But sometimes it’s necessary. Vaccination is one of those times.

gretchen @ 18, I remember in high school when my mom took me to the county health department to get the hepatitis shot.  I was pretty annoyed (who likes needles?), and she sort of rolled her eyes and said “look, it’s so you can have sex, ok?”  And as I write this, it occurs to me to ask her about my young sister - she might be religious and fairly conservative but has always been practical, and I’m really going to have something to say if my sister doesn’t get the shots.
O for the days when conservatives were practical.

I take issue with mandated vaccinations because of the simple fact that an individual in my opinion should be free to do with their bodies and their families as they choose.

No one is forced to get vaccinated in this country. There is considerable social pressure to do right by your community and support herd immunity because you are not forced to get vaccinated. Considering the history of actual government medical abuses liked force sterilization programs, it is disingenuous and absurd to portray the high recommendation for vaccination as some sort of Orwellian tyranny waging war on bodily autonomy. Your rights are not under attack because you have to fill out one more form to exempt your child from a medical procedure that could keep them from up hurting other children.

Anyone else remember when you had to get blood tests for gonorrhea and syphilis before tying the knot? It would be interesting to see how reactions to gardasil among the conservatives would change if you had to get a test for HPV. I bet within a couple of years they would be miraculously won over.

Actually, horse-and-buggy accidetns were a serious problem, back in the day.

Ismone at 2:41 a.m.
Certainly it’s a new vaccine compared to, but just looking Gardesil up on Wiki, the study of its effectiveness was apparently terminated because the researchers found it to be so effective that they felt it was unethical to be withholding it from the control group. I don’t have any expertise in such matters, but it sounds like a large study. I also don’t know how likely concerns over how long the vaccine might last are to be founded.

The problem, though, is that if everyone took the view that we need to wait before we give this to my kid, no vaccine would ever become accepted. In public health, we do have to take one for the team because of the concepts of herd immunity. And that includes children. People, I think, don’t want to this that about their kids, but it does.

And one of the interesting questions about HPV and cancer, and people who clear the virus and who do not—is what is different about these people?  In short, is failing to clear the HPV not just a statistically random thing, but evidence of a dysfunction of the immune system?  And just like my hives and sinus condition, could they be stress related?  And could that stress be alleviated by proper nutrition and fitness?  These are not crazy things to think.  For most illnesses, the best thing to do is rest and reduce stress.

This seems reasonable. I know I resist going to the doctor when I have a bad cold or the flu, which my work often tries to push me into because they like proof I’m not malingering. I don’t see the point of exposing more people than necessary to my virus for the dubious benefits of going there. And I generally feel like the last thing that’ll help me get better is to drag me out of my comfy chair in the basement, where the benefits of rest, drinking Diet Vernors and dozing while watching Lord of Rings on DVD can help heal me. All of us have the inclination to do something when someone comes to us with a problem (which is generally a good thing for civilization), but it can lead to symbolic solutions like your antibiotics.

Where you lose me on reasonableness, is when this gets taken to vaccine skepticism, because there’s more to vaccination than just lowering your own chance of getting sick. I wouldn’t be surprised that your healthy self is less likely to suffer from HPV and even cervical cancer caused by HPV, because healthy immune systems fight off viruses better. (There’s a lot of unscience in that paragraph, I think, but we’ll role with it.) But I don’t have any confidence that all the sexual partners you’re going to have in your life will be similarly paragons of boosting their immune systems or won’t have have some other unknown risk factor that makes them way more likely to have HPV cause a cancer.

Rea @9:36:
Yeah, I was thinking that, too. I just heard about some Amish folks dieing in a buggy crash down toward Shipshewana, Indiana.

I wish liberals would react to that argument by laughing wildly instead of coming up with rather irrelevant rejoinders like, “If your daughter stayed a virgin, she could still be raped or marry a man who isn’t a virgin.”  Okay, sure, but she’s not going to stay a virgin until she’s married. So why are we talking about it like it’s a real option?

I continue to use this argument for certain people.  A lot of conservatives are impervious to facts.  Even the few that accept that Evangelicals are more likely to have sex at younger ages will continue to believe that their special precious daughter is different, mainly because all those other Evangelical parents are doing it wrong but they’re doing it right.

Of course these people are wrong, but since there’s little chance of convincing them, I’d rather see their daughters (and sons) protected from HPV no matter what it takes.  I don’t really like the idea of using their child as a pawn in some ideological purity game where she can’t get the vaccine if it’s for the wrong reason.  I don’t want her to get cancer and then say “See?  I told you so” when her parents realize that they should have accepted that she would have sex.

These people won’t believe that their daughter will do anything “bad”, but they are a lot more likely to believe that someone else will do something bad to their daughter.  I don’t enjoy reinforcing their delusions, but I’m willing to do it anyway if it protects people from cancer.

The hepatitis vaccine is also given at 12 or so to prevent sexual transmission, but they don’t spell that out as explicity - it’s just “you don’t want your kid to get hepatitis”.  My pediatrician said they started explaining it differently, but everyone’s reaction was “my baby won’t be having premaritial sex so she won’t need it”, so they just started saying it’s to prevent hepatitis.

I think this is easier with Hepatitis, because there are different types and they aren’t all STDs.  I’m pretty educated and even I don’t know which is which off the top of my head, but I do know that you can get one type from eating unwashed produce.  So it’s easier for uptight parents to disconnect the vaccine from sex.

So I think what we need to do is start referring to “regular” warts as HPV too, or somehow make the link to the general public between this disease on genital areas and all other areas of the body.  Although now that I think about it, this could backfire.  Now that people generally know that cold sores are a type of herpes, I met at least one guy who really freaked out over an innocent cold sore.  He was somehow oblivious to how common they are, and when I told him that I had been getting them since I was a kid, he accused my parents of sexually abusing me.  Yeah, that was weird but I don’t think it’s very common.

It’s not like HPV is the only STI around.  If you need that to “scare your kid straight,” you can always use herpes or HIV or whatnot.

The reason the right wing gets all crazy about HPV in particular is because it can be transmitted even with perfect condom use, so it’s their go-to STI for the “condoms don’t protect you against STIs” message.  Once you prevent HPV through a vaccine, condoms really can protect you from every other STI.

Once you prevent HPV through a vaccine, condoms really can protect you from every other STI.

No, herpes and pubic lice can be spread even with perfect condom use, although it is obviously less likely.

Witless chum,

I would have gotten the vaccine myself, but I am considered too old now.  I am concerned with the idea that everyone should get the vaccine before there is significant data on it.  Now, granted, I got the Hep B vaccine before there were decades of data on it.  But that was an individual choice.  I think it is fine to praise the efforts at vaccines and encourage vaccination, but I am really by Mighty Ponygirl saying that everyone who doesn’t vaccinate their child is some kind of abuser.  Not so.

Some of us just want to know how well it works, and how often it has to be given.  Regardless of what the early clinical trials on gardasil said, we need to know what long-term effectiveness is like, for one.

bananacat,

The vaccine is for Hep B, which is generally recognized as an STD.

Talmageb #20: The states have broad powers to protect the health, welfare, and security of citizens. The Constitutional right of states to mandate vaccines was upheld by the Supreme Court beginning with smallpox in 1905; this precedent has been used in support of many public health measures since. So, yes, the state can make you get a shot, provided they have reasonable exceptions (for health or belief reasons). 

Bananacat #34: Hepatitis A is passed through fecal-oral contact, so it’s often passed through eating food prepared by HAV-infected people who didn’t wash their hands after pooping. Hepatitis B, C, and D are bloodborne infections. They CAN be passed sexually, but only if blood is exchanged during sex (e.g., through small cuts or sores). However, they are usually passed by shared needles.

witless chum,

I also do not think anyone has an obligation to get vaccinated to protect others.  I think it would be a good thing to do so, but I do not think I am obligated to take anything into my body to make someone else safer.  OTOH, I stay home when I am sick.  I do think it is an obligation, and one people often ignore, to avoid infecting others when you are sick.

I’m thinking if there actually was a real historical Jesus (and he wasn’t the equivalent of Jim Jones or David Koresh back in the day) he would have been shocked to see what was already being done in his name within days/weeks after his death. 
Comment #11: MikeEss on 09/21 at 10:39 PM

As Woody Allen said, if Jesus came back and saw what’s going on in his name, he’d never stop throwing up.

I also do not think anyone has an obligation to get vaccinated to protect others.

Once again, that is only a privilege you are granted because of the high rate of vaccination. As soon as the unvaccinated become large enough to become a health threat, those privileges will end. You can only choose not to be vaccinated as long as almost everyone else makes a different decision—ironically, the only reason there is no obligation to vaccinate is because the public regards it as an obligation to vaccinate.

Ismone, thanks for sharing your experience.  I too was prescribed a broad spectrum antibiotic for years, by a doctor who seemed completely unconcerned that the antibiotics were producing no change in my symptoms, and was repeatedly dismissive of my questions about possible side-effects (I was a teenager at the time, and while I could have done the research myself, an adult in a white coat made it very clear that my questions were unwelcome, so I dropped the issue).  I had never thought that this could be related to any of my subsequent health issues, but after reading your comment I did a quick search and it seems that they might be.  I doubt anything will come of this, but having an unexplained chronic health issue makes it really easy to think that it must somehow be my own fault (I guess this comes back to Amanda’s post: the tendency to see health problems as evidence of a personal moral failing) so it’s nice to know that there might be an explanation for the whole thing.

Given that, I completely agree with your remark about why liberals don’t trust doctors.  Just because somebody doesn’t trust doctors doesn’t mean they are anti-science.  Just because science is great doesn’t mean that the people who (supposedly) use science are going to be perfect at their jobs.  At least in the United States, doctors tend to resist evidence-based medicine, preferring to go with their guts.

But I do disagree with Amanda about why some liberals, myself included, aren’t so big on throwing a vaccine or a standard medical treatment at a problem, and why some think general health and nutrition boosts our immune systems.  For *years* I was given antibiotics for my sinus infections, 10 years ago I stopped taking them because I thought they did not work.  Turns out, the do not.  In part, because many infections are viral, in part (and this is the part doctors knew all along) because it is so hard to get drugs in the sinuses through oral medication—to the point that sinus cancers are treated with radiation and never chemo because the drugs won’t get there.  Basically, by giving me those antibiotics, they screwed with my GI tract (which broad-spectrum antibiotics will always do) and didn’t do me any good, and contributed to the problem of overusing antibiotics.

Also, regarding general health and nutrition and the immune system—I know the health problems I have had when my nutrition has been poor and my stress levels high.  I had a serious unilateral sinus condition that at least one of my doctors thinks is highly related to on the job stress.  (I left that job.)  I have known people who get hives from stress, I have gotten hives from stress.

And one of the interesting questions about HPV and cancer, and people who clear the virus and who do not—is what is different about these people?  In short, is failing to clear the HPV not just a statistically random thing, but evidence of a dysfunction of the immune system?  And just like my hives and sinus condition, could they be stress related?  And could that stress be alleviated by proper nutrition and fitness?  These are not crazy things to think.  For most illnesses, the best thing to do is rest and reduce stress.
Comment #19: Ismone on 09/22 at 02:41 AM

Clearing the virus doesn’t mean you’re not going to get cancer.  There are a bunch of strains of it and the next one might not be so benign.  You could get it more than once, or it can go dormant and reactivate when your immune status is low (like if you got sick or old).  “Stay healthy” is not a valid response.  You can be made unhealthy, not your own fault, at any time.  Get hit by a car.  Get cancer from environmental sources.  Get exposed to a virus or bacteria or fungus your immune system has never seen.

And those doctors giving you antibiotics for viral infections only means they were stupid.  When did this happen?  At that point maybe this wasn’t good practice any more.  There are hack doctors out there who learn nothing substantive after they graduate medical school, because it’s easier to just sell the drugs and take the cruises.

Compare it with this particular vaccine, which is supported by actual research doctors.  We already know that vaccines do work to prevent a virus and we already know that this vaccine works to prevent HPV. 

Do you think later we’re going to find out they don’t?  I don’t get what you think is going to happen later to “prove” it was stupid to get the vaccine.

I also do not think anyone has an obligation to get vaccinated to protect others.  I think it would be a good thing to do so, but I do not think I am obligated to take anything into my body to make someone else safer.  OTOH, I stay home when I am sick.  I do think it is an obligation, and one people often ignore, to avoid infecting others when you are sick.
Comment #39: Ismone on 09/22 at 01:16 PM

So only if you personally get sick are you to blame if you pass on a disease?  Sorry, but in my opinion, you and Typhoid Mary can both go to Hell.

I mean, it’s magical thinking that somehow you will be healthy enough (left) or virtuous enough (right) that you can avoid getting the disease so you don’t need the vaccine.  Magical thinking works until it doesn’t, then you can either come up with some rationalization why you were weakened (like N rays) or you can admit that you aren’t bulletproof.  By then it is TOO LATE to repair the damage.

But it takes a special kind of self-centeredness to not care if you make others sick.

Once again, that is only a privilege you are granted because of the high rate of vaccination. As soon as the unvaccinated become large enough to become a health threat, those privileges will end. You can only choose not to be vaccinated as long as almost everyone else makes a different decision—ironically, the only reason there is no obligation to vaccinate is because the public regards it as an obligation to vaccinate.

“I’m not going to get vaccinated” means the same thing as “I’m okay with you catching this.”

tal, for religious idiots whose superstitions prevent them from getting vaccines, there’s usually an opt-out option. Opt-out policies are best because they protect religious rights while maximizing vaccine use.  Without mandates, a lot of people forget to get around to vaccinating their kids.  With opt-out, they at least have to fill out some paperwork; as long as they have to do something, most parents will go with vaccination.

So your concerns have already been addressed.  If religious exemptions are your sole concern, they have actually been addressed, and you should feel free to support mandates now.

Ismone @19: Your conflation of antibiotics and vaccines demonstrates why you should NOT assume you know better than scientists how the body works. That’s a really, really ignorant conflation.  They don’t work the same.

Tyro @41: I would add that beyond just the privilege question is the fact that it is, in fact, a moral responsibility to get vaccinated if you can.  Turning your nose up to vaccinations because you think you “eat right” is a profoundly selfish act.  Okay, so fine. Let’s assume for the sake of argument your amazing diet confers immunity benefits that science has never been able to prove.  You’re still contagious while you’re kicking the disease you got.  Unless you’re prepared to argue the young and the old and those who aren’t as lucky as you generally “deserve” to die if they catch it from you, you’re a MASSIVE asshole.  It’s like driving drunk because you’ve got some political immunity and good airbags.

If you’re prepared to argue that the young and the old and those with compromised immune systems deserve to die if they catch a disease, you are also a massive asshole.  So really, either way.

I am concerned with the idea that everyone should get the vaccine before there is significant data on it.

Yes, because the vaccine was just cooked up by some random dood in a basement, and it’s not like there has been extensive testing for both safety and efficacy or anything like that.  Oh, wait.

The truth is that no amount of data will ever be enough for you.  The line you draw is completely arbitrary and will continue to shift forever.

I also do not think anyone has an obligation to get vaccinated to protect others.

Ayn Rand fan?

Paul @ 29: Massachusetts only got rid of their blood test requirement in 2005, and Mississippi and Montana still test for syphilis and rubella, respectively.

The point’s already been made a couple times, but let me make it a different way.

OTOH, I stay home when I am sick.  I do think it is an obligation, and one people often ignore, to avoid infecting others when you are sick.

How do you know you are sick?  If it’s b/c you feel sick*, you should know that a lot of diseases are contagious in the latent stage between infection and the onset of symptoms. 

Might want to rethink your strategy there unless you’re cool with hypocrisy.

*If you have a pathology lab in your basement, my apologies.

Amanda,

I know the difference between vaccines and antibiotics.  My point is that many times, standard medical procedure is not backed by science.  See also, statins being prescribed to women.  (Yes, statins are not vaccines, either.)

If you want a vaccine-specific example about why myself and other liberals don’t just fall in line every time a GP tells us to do something, look into the chickenpox vaccine, and how it may be causing more and more shingles both among those who have the vaccine (instead of the disease) and those in the general population who had the disease.  The basic theory behind the uptick in shingles cases (which are painful, and can lead to missed work/lost jobs) is that in the past, because chickenpox was so prevalent in the population, those of us with initial immunity from childhood infections had that immunity strengthened when they were re-exposed to chickenpox throughout their lives.  Now that it isn’t happening, we may actually have more illness at ages where are bodies are less likely to be able to deal with it.  That is why, even when a disease is terrible, like cervical cancer is, the answer isn’t always “vaccinate everyone all at once.”  Paradoxically, certain vaccines do not work as well as others, and in the case of the chickenpox vaccine, we may be creating more illness by mandating it.

But I absolutely agree with you that “sexytimes disease” is not a valid counterargument.  And it pisses me the fuck off that conservatives want to punish people who have sex.

Tyro,

I am vaccinated for just about everything, including Hep B and a recent re-vaccination of DTP because I am around my friend’s small children.  I do not get flu vaccines and I was denied the HPV vaccine based on age.  I would refuse the chickenpox vaccine, unless I had contact with an at-risk population, and only if I could be sure I would get routinely re-vaccinated.  I am not saying no to all vaccines, or no to smallpox or dtp or mmr.  My point is that Amanda is setting up a straw liberal.  Those who don’t think that a parent is a bad parent for not wanting their kid to have HPV sometimes have very good reasons for being skeptical of vaccination programs for new vaccines, before we have long term data.  I am not saying parents should not vaccinate their children, I am saying it is a personal, and loaded choice.  I would vaccinate mine.  But I would not feel that someone was being a bad parent for refusing HPV vaccines, the way I would think they were for refusing some others.

So this is not about an ad hom against me.  It is about sound medical policy.  Which is why, unlike Amanda, I see the ohhh, sexytimes objectors as different from the liberal cost-benefit analysis objectors.

old feminist,

The bigger problem was the fact that the antibiotics, taken orally, cannot get to your sinuses.  That was always known.  Doctors do not know when you have a respiratory tract infection (or many infections) whether they are bacterial or viral in nature, so many times if antibiotics are prescribed the doctor never knows 100% that there is a bacterial disease, unless they have cultured for a bacteria and found it.

Regarding the researchers on the HPV vaccines, the problem is their is no longitudinal data yet.  So we don’t know how long the vaccine works for.  We don’t know what the ideal age is to give it at.  We don’t know if boosters are needed.  We don’t have a long-term side affects profile.

That does not mean I would not give it to my own children, if I had it.  I am actually in the process of convincing a Biology PhD friend of mine with two sons to give it to them because of its linkage to sinus and throat cancers.  Plane Crazy’s comment at #22 is brilliant and touching on this point.  And Plane Crazy, so glad to hear you are in remission.

With regard to clearing the virus, the generally accepted wisdom right now is that if you were sexually active by your early 20’s you have by definition cleared a strain by 30, you are at very low risk from ever getting cancer from HPV.  I plan to look into this, and if this is incorrect, I will get someone to give me the vaccine off-label.

I am not going to bother responding to ad homs.

I will say that I think there is a tension between this and between the pro-choice views of others on this blog.  Either our bodies are completely ours, or they are not.  Some people arguing for medical mandates are going against that.

Regarding staying home vs. vaccinating and making others sick.  Staying home should be practiced because it protects others from a known illness (not a risk) and does not put the patient at any higher risk on an individual level.  If you do not have symptoms, your viral load is very low, and the likelihood of you passing on an illness is very low.  There are many, many illnesses that we get that cannot be vaccinated against, which is why staying home should be a moral obligation.  And yes, Emmett, during the latent phase of a disease, you can infect, for certain diseases.  How many of those diseases are their vaccines for?  Yeah, I thought so.

For those calling me self-centered—I have a current DTP vaccine so I cannot give a child the whooping cough.  If you are around small children, and do not, or do not know, well, shame on you.  Considering vaccines on an individualized level does not mean not getting vaccinated.  It means considering the costs and benefits.

bananacat,

I would say about 20 years of data, with routine retesting for immunity, and studies on the efficacy of the vaccine would about do it for me.  I would be very skeptical of any parent at that point who was a conscientious objector, unless they had a really specific reason. 

As I have said, I tried to get the vaccine.  I may still try to get it off-label.  The reason I have a dog in this fight is because Amanda is misrepresenting why certain liberals see vaccines as an individual choice, especially new ones.

It isn’t anti-science.  It is because some of us are pretty involved in reading the literature, and what we do and do not see in that literature convinces us that like many medical treatments, vaccines and their timing can be a tradeoff.

So, here are some reasons to get the HPV vaccine, but first, a source stating we do not yet know how long the vaccine is effective for:

http://www.ncbi.nlm.nih.gov/pubmed/21466509

HPV is associated with Nasal Inverted Papillomas undergoing a malignant transition:

CONCLUSION:
the recurrence and malignant transition of NIP are related to HPV infection which may be attributed to the wider range of infected cells in these cases. The higher infection rate of high risk HPV type is one of the reasons for malignant transition.
http://www.ncbi.nlm.nih.gov/pubmed/17727781

HPV is also associated with metasteses in head and neck cancers (correlation is not causation, as the study authors noted):

HPV-16 DNA detection in lymph nodes of patients affected with HPV-16(+) oropharyngeal cancer is indicative of metastatic involvement. Tumor-free lymph nodes with a high viral load value would suggest the presence of occult lymph nodes metastasis and the opportunity to use HPV-16 DNA as a metastatic marker. Further investigations are needed.
http://www.ncbi.nlm.nih.gov/pubmed/21930979

Evidence for causality re: HPV and HNSCC (head and neck squamous cell carcinoma):

There is now sufficient evidence for a causal role for HPV in HNSCC. As in cervical cancer, HPV requires oncogenes and co-factors for tumor development.
http://www.ncbi.nlm.nih.gov/pubmed/21792686

(old feminist, this may be why my doctor thinks sexually active women over 30 aren’t at risk—if we had the co-factors, we would know it by now.)

And, on non-sexual transmission of HPV

Mother to child:

Current evidence is strong enough to conclude that human papillomavirus (HPV) can be transmitted both sexually and non-sexually. The debate on HPV infections in children still continues but it is more focused on HPV prevalence than on transmission modes. HPV DNA detection in amniotic fluid, foetal membranes, cord blood and placental trophoblastic cells all suggest HPV infection in utero, i.e. prenatal transmission. Based on recent meta-analysis, vertical transmission occurs in approximately 20% of cases. Most of the mucosal HPV infections in infants are incident, persistent infections in oral and genital mucosa being found in less than 10% and 2% respectively. The mother seems to be the main transmitter of HPV to her newborn, but subsequent HPV infections are acquired horizontally via saliva or other contacts.
http://www.ncbi.nlm.nih.gov/pubmed/20553530

Sexual and non-sexual transmission, described:

HPV infection is the most common of all sexually transmitted diseases. It is estimated that two thirds of those who have had sexual contact with HPV-infected persons, will become infected [3]. Oral HPV infection can be acquired by oral-genital contact, by mouth-to-mouth contact, or possibly by autoinoculation [4,5]; and in infants by mother-to-child transmission [6,7]. How HPV infection of the upper respiratory tract occurs is not clear, but it may be by mucous carriage of virally infected squames from the mouth, or from the mouth of another person to the oropharynx and larynx [8].
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788520/

“I will say that I think there is a tension between this and between the pro-choice views of others on this blog.  Either our bodies are completely ours, or they are not.  Some people arguing for medical mandates are going against that.”

So, I’m curious.  Are there any vaccines that you think should be mandatory?  Or do you think it should always be up to people to decide for themselves whether or not to be vaccinated?  Are there any other areas where you think people should be allowed to decide for themselves whether or not to behave in a manner that causes risk of harm to others?

Ismone, I’m relatively cdertan you were not denied the HPV vacine due to your age.  I’m willing to bet really money that you mean that YOUR INSURANCE WONT COVER it.  Yes, I meant to shout.  You are being a self-righteous ass by insisting you ignorant friends and relative shouldn’t have to fill out a piece of paper indicating that they are also self-righteous assholes willing to infect others who can’t, not wont, immunize for whatever reason they aren’t willing to do what is pretty universally acknowledge aas the right thing to do.  That they are willing to risk their own childrens’ health and that of their childrens’ friends does IMO make them bad parents.
Mandating the vacine means that insurance has to cover it.  If there is an opt out, anyone who fights mandates is a major asshole for giving insurance companies an out to having to cover it for those who want it.

Being pro-choice does not endanger swaths of society.  Unless you are arguing that an embreo or fetus is a person, being pro-choice does not effect public health in any way beyond allowing a woman to ensure her own safety from pregnancy-related health issues, which are not insubstantial to even the healthiest women.  Total logic fail there; apples and bananas, as it were.

Kit-Kat,

I support existing opt-outs.  I also support research to prove safety and come up with good schedules so that proper boosters can be given.  As I stated upthread, about 20 years of data is what I would want to be sure of things like efficacy or side affects.

helen w.h.,

I told my doctor I would pay out of pocket.  As I am over the age of 26, she said she would not give it to me because it would be off-label.  Mandating the vaccine does not mean insurance has to cover it.  I do know another doctor who might give it to me off-label.

Not all vaccines are created equal.  Read what I wrote about chickenpox.  My position is reasonable—that for new vaccines, the cost-benefit analysis that liberals go through is reasonable, it isn’t some kind of woo like Amanda is saying it is.  It is the *reason* I am considering getting HPV off label, if I can find a fucking doctor who will give it to me.  It is the reason my friend may do the same for her sons.  And read my post about the other methods of transmitting HPV and the other diseases it causes.

I am not against the vaccine.  I am tired of amateur science writers stereotyping myself and other liberals for looking at the data carefully when a vaccine is new or when the protocol is changed.

One pro-choice argument is that a living, born person has no right to your body, therefore neither does a fetus.  That idea, that other living people have no right to our bodies, our organs, our tissues is the incongruity I see there.

So, the 20 years of data? Comes from where? Just as long as its not you and yours?

Its a vaccine. For a highly contagious virus that causes freaking cancer. Opting out should be as difficult as opting out for DTP or MMR.

and a sense that sex is something you really have to plan for, which discourages spontaneous sexual intercourse.

Which is why this agnostic, daughter of a liberal (e.g., pro-sex-ed and pro-choice) Presbyterian minister, delayed having sex in high school. It just seemed like too many things to keep track of, and I already had so much else to worry about in my life. Even as a college student, on birth control, I still have trouble taking it at the same time everyday, and sometimes all the effort doesn’t seem like it’s worth it if I’m not with someone I really, really like.

I would say about 20 years of data,

What vaccines have benefitted from 20 years of data?

What science proving we shouldn’t use statins in women?  One study that shows a slightly elevated risk of some cancers?

Isn’t that kinda like worrying about death from cancer when you’re standing in the middle of a street?  Or complaints about the reduction in number of people who should get mammograms as regular course?  One thing’s additional risk might be less than the original risk it mediates.  And we can only tell that with evidence-based study.

For instance, my quality of life is greatly increased by having estradiol available.  Without it, I’d have not gotten through the last ten years.  A little worry about cancer later in life… Hardly comparable.

And about pro-choice vs vaccine requirements… That’s stupid.  We require lots of things of people to not endanger others.  Wash your hands before returning to work, wear a hairnet, don’t drive on the sidewalk.  A vaccine is not like needing your kidney or blood!

A note about healthy living and HPV: the only two factors that seem to work (on a POPULATION-WIDE, not individual basis) for clearing HPV are folate supplementation and not smoking.  So yeah, I think healthy living is helpful.  But it annoys the heck out of me when people self-righteously claim that their herbs/liver cleanses/running habits/naturally superior lifestyle/etc is what cleared their mildly abnormal paps.  Most mildly abnormal paps clear on their own; statistically more clear with the two variables noted above.  Otherwise, it’s a toss of the dice and roll of fate - some people just pull the short straw, and that doesn’t make them anything other than unlucky.  But, then, aside from a few true lifestyle diseases, this kind of rhetoric (I-won’t-get-sick-‘cause-I-live-healthy) always makes me cranky.  No one asks for cancer, ya know.

Crissa,

Google is your friend.  Statins do not now, and never have worked to reduce the incidence of heart disease for women.  Pfizer had this data initially, and released it even at that time, no one paid attention to it.  Any doc. who prescribes statins for women does not get it. 

Tyro,

It is likely that at the end of 20 years, we will realize that a vaccine for varicella zoster (chicken pox) was a mistake.

I will say that I think there is a tension between this and between the pro-choice views of others on this blog.  Either our bodies are completely ours, or they are not.

This is a pretty silly analogy. A woman’s pregnancy does not affect the larger community around her. But if your body is carrying infectious diseases that may affect my body, that becomes a communal concern.

It is likely that at the end of 20 years, we will realize that a vaccine for varicella zoster (chicken pox) was a mistake.

It(the chickenpox vaccine-ed) has been available in the U.S. since 1995 to inoculate against the disease.

Wiki Link

Furthermore, follow-up evaluations took place in the United States of children immunized that revealed protection for at least 11 years. Also, studies were conducted in Japan which indicated protection for at least 20 years.[23]

Varicella Vaccine Wiki Link

So, can you tell me what complications we can expect in the next 4 years here in America that haven’t turned up in the previous 16 years of usage, or 20 years of usage in Japan as I just cited in my second link?

Talmageb: I take issue with mandated vaccinations because of the simple fact that an individual in my opinion should be free to do with their bodies and their families as they choose. 

A father should be free to do what he pleases with the bodies of his daughters? You really, really think that?

Parents don’t own their children. They don’t have a right to do what they please with their children’s bodies. You can take issue with that all you like, but if you try to take action on your “simple fact” that you own your family and should be free to do with your children what you like, no matter what harm that causes, then I hope someone calls Child Protective Services on you.

Parents have a responsibility to take care of their children. As a society we all have an obligation to take care of each other. Making vaccines mandatory is a public health issue: we all have an obligation to protect each other from transmissable diseases when we can. Making vaccines mandatory in the US healthcare system means kids whose parents can’t afford to pay for the vaccines will get them anyway.

I am uncomfortable with the idea that the State should be able to tell my paranoid relatives that they have to do something that they are uncomfortable with whether I think their reasons are valid or not.

Your relatives have a right to decide each for themselves that they’re going to die for their religious beliefs, if that’s what they want. Or to suffer ill-health, or experience awful pain, because they think God wants them to suffer. That’s their right. They don’t have a right to deny their children medical treatment, especially not something of such basic public health as a vaccine.

Ismone; “OTOH, I stay home when I am sick.  I do think it is an obligation, and one people often ignore, to avoid infecting others when you are sick.”

Spoken like a true wealthy person. How fortunate you are to be so privileged to be able to stay home whenever you’re sick. How privileged you are for it never to have occurred to you that less well-off people than you don’t stay home when they’re sick because they can’t.

What vaccines have benefitted from 20 years of data?

She just pulled 20 years out of her ass because it’s a long enough time that she knows she’ll never get called on it.  There’s no reason that 20 years is some magical number where it’s suddenly “enough” data.  In 20 years she’ll still refuse the vaccine, but everyone will have forgotten about her post on this blog.  It’s a number she picked because she’s trying to sound reasonable but without actually being held to what she says.  It’s a cop-out so she doesn’t have to admit to herself or others that she’s a denier who will never be convinced by any amount of data.  If clinical research isn’t enough to convince her, then 20 years of high effectiveness won’t matter either.  What she really wants is 20 years’ worth of bad anecdotes and “testimonials” to rely on so she can continue to distrust the vaccine but pretend there’s some evidence behind it.

“Statins do not now, and never have worked to reduce the incidence of heart disease for women.”

That is a vast, vast oversimplification of a complicated issue.  To say the least.

Ismone:  “I am not going to bother responding to ad homs.”

You’re as bad at logic as you are at medicine.  Ad hominem fallacy is basically saying “you’re ugly therefore you are wrong,” meaning that I insult you in an irrelevant manner and use that insult as a basis for not discussing your argument.

Correctly characterizing you as self-centered because you don’t care if others get sick so long as you can pretend your virtuous living protects you from disease doesn’t qualify.  The characterization is based on your own erroneous statements which are totally relevant to the argument at hand.

That you don’t like being called self-centered doesn’t matter.

The fact that there is no statistically proven cardiovascular benefit from the use of statins for cholesterol reduction in women was first publicly disclosed by Uffe Ravnskov in his book, Cholesterol Myths and has been corroborated repeatedly by numerous longitudinal clinical studies.

The ASCOT study, the largest randomized clinical study of statin effectiveness in women, found that the women who took Lipitor, developed more heart attacks than women in the group given placebo.

While not statistically significant this finding hardly supports cardiovascular benefit. In this ASCOT study, 2,000 women were included among 10,000 patients having elevated blood pressure and at least three other cardiovascular risk factors.

Again and again, clinical studies have failed to show that the use of statins lowers cardiovascular risk in women who do not already have coronary heart disease or diabetes.

http://www.spacedoc.com/women_statins.htm

Given that statins can cause liver damage, they shouldn’t be used when there are other things to try to lower cholesterol, such as increased exercise and/or weight loss, in both men and women, if there is/are no pre-existing illness(es) as mentioned above.

Again and again, clinical studies have failed to show that the use of statins lowers cardiovascular risk in women who do not already have coronary heart disease or diabetes.

Note this reads, “who do not already have coronary heart disease or diabetes.” 

How does it affect cardiovascular risk in those women who do have coronary heart disease or diabetes?  It helps them.  While their lives aren’t typically any longer, they experience fewer strokes and heart attacks and undergo less surgery.

http://heartdisease.about.com/od/cholesteroltriglyceride1/a/statins_women.htm

Patients with multiple risk factors (diabetes, smoking, obesity, sedentary lifestyle, hypertension, etc.) stand to gain more from statins that those in whom cholesterol is the only risk factor. High risk patients should take statins. The present controversy is pretty much limited to patients at intermediate risk….

Non-fatal heart attacks, strokes, and revascularization procedures, while not as bad as dying, are still pretty bad. Significantly reducing the risk of having one or more of these events will, after deliberation, seem like a worthwhile endeavor to many.

Bottom line, if your doctor prescribes statins to you based only on a high cholesterol number and nothing else (no other risk factors) then it’s probably not going to help you, and it doesn’t come risk-free (muscular pain is one particularly common and bad side effect). 

If you’re in the high-risk category, it may well help you.

NB my post was just elaborating on what DA said.

if your doctor prescribes statins to you based only on a high cholesterol number and nothing else (no other risk factors) then it’s probably not going to help you

oldfeminist, when I was 46 years old, I had horrid LDL & HDL levels, my cholesterol was 203 and I wasn’t massively obese, perhaps 25-30 lbs over the average for my height and build, and I wasn’t eating a lot of meat or drinking a lot of milk, or so I thought at the time.

My sister the nurse(BSN, RN) told me that because of my age statins would probably have an adverse effect on my liver(let alone the muscle aches you mentioned), and she recommended exercise and weight loss, and so I started walking every day to achieve both ends.

As always, these posts do not constitute medical advice, please consult a physician or family doctor if you have questions about your own situation.

oldfeminist,

If there is anything substantive you said that I did not respond to, point me to it, and I will.

It was an ad hominem.  You used it as an insult, you did not explain *why* defending an individualized cost benefit analysis for new vaccines was bad.  It was meant to discredit, not to defeat any argument I was making.  So, textbook ad hominem.

bananacat,

Nope, 20 years is about what I think it takes to get enough data about long-term effects.

And read for comprehension.  I have the vaccines for Hep B and DPT, the only reason I personally do not have the HPV vaccine is because my doctor will not prescribe it off-label.  I am defending parents for engaging in individual CBA for vaccines for their children.  The only vaccine I have said I will not get is chickenpox, as I do not work with high-risk populations, and have had the illness, and no one is saying that I should get it, or even defending the vaccine.

Again, name-calling ain’t argument.

Whoever criticized me about staying home:  you are right, I do have that privilege, although it actually made people at the last job I was at think that I was going to quit and was out interviewing.  So I could have lost my job over that privilege.  A lot of similarly-privileged people that I worked with and who I known did and do not stay home, even though there were some known immunocompromised individuals in our office.  None of those people got sick when I had contact with them.

Dark Avenger,

Problems with the vaccine, and how it is thought to affect herpes zoster (shingles) while reducing childhood varicella incidence:

This study updates previous work on modelling the incidence of varicella and Herpes Zoster (HZ) following the introduction of childhood vaccination. The updated model includes new data on age-specific contact patterns, as well as data on the efficacy of zoster vaccination in the elderly and allows for HZ among vaccinees. The current study also looks at two-dose varicella childhood programmes, and assesses the combined impact of varicella vaccination in childhood and zoster vaccination of the elderly. The results suggest that a two-dose schedule is likely to reduce the incidence of varicella to very low levels, provided first dose coverage is around 90% and second dose coverage is in excess of 70%. Single dose varicella vaccination programmes are expected to result in large numbers of breakthrough cases. Childhood vaccination is expected to increase the incidence of zoster for more than 40 years after introduction of the programme, the magnitude of this increase being influenced primarily by the duration of boosting following exposure to the varicella zoster virus. Though this increase in zoster incidence can be partly offset by vaccination of the elderly, the effectiveness of this combined strategy is limited, as much of the increase occurs in those adults too young to be vaccinated. Childhood vaccination at intermediate levels of coverage (70% and 60% for first and second dose coverage respectively) is expected to lead to an increase in adult varicella. At high coverage (90% and 80% coverage) this is unlikely to be the case. These results will be used to inform a cost-effectiveness analysis of combined varicella and zoster vaccination programmes.
http://www.ncbi.nlm.nih.gov/pubmed/21277405

Overall annual incidence rates of herpes zoster (shingles) among U.S. military members increased steadily from 2000 (1.40 per 1,000 person-years) to 2010 (2.38 per 1,000 person-years). Incidence rates were higher among females than males and increased with age. Higher rates during the summer than other seasons may be explained by differences in exposure to UV radiation. Declining primary varicella (chickenpox) disease among children may lessen natural boosting of immunity to varicella zoster virus in adults and increase their risk of herpes zoster.
http://www.ncbi.nlm.nih.gov/pubmed/21815711

That’s very interesting, but there’s now a vaccine specifically for zoster prevention now in the elderly:

The vaccine for shingles (Zostavax®) is recommended for use in people 60 years old and older to prevent shingles. The older a person is, the more severe the effects of shingles typically are, so all adults 60 years old or older should get the shingles vaccine.

The shingles vaccine is specifically designed to protect people against shingles and will not protect people against other forms of herpes, such as genital herpes. The shingles vaccine is not recommended to treat active shingles or post-herpetic neuralgia (pain after the rash is gone) once it develops.

Disease Protection

In a clinical trial involving thousands of adults 60 years old or older, Zostavax reduced the risk of shingles by about half (51%) and the risk of post-herpetic neuralgia by 67%. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups.

Research suggests that the shingles vaccine is effective for at least six years, but may last much longer. Ongoing studies are being conducted to determine exactly how long the vaccine protects against shingles.

Since having chickenpox isn’t a contraindication for this vaccine, I would bet garbage to donuts that it could be given to those who have received the chickenpox vaccine as well.

You’ve given some information that seems to imply that high rates of vaccination are likely to be protective against adult varicella, so unless you think that a high rate of vaccination shouldn’t be attempted, I’ve no idea why you think the articles you excerpted and linked to are a reply to my question.

Dark Avenger,

Right, but the first abstract I posted said that vaccinating the elderly wouldn’t completely solve the problem:

“Childhood vaccination is expected to increase the incidence of zoster for more than 40 years after introduction of the programme, the magnitude of this increase being influenced primarily by the duration of boosting following exposure to the varicella zoster virus. Though this increase in zoster incidence can be partly offset by vaccination of the elderly, the effectiveness of this combined strategy is limited, as much of the increase occurs in those adults too young to be vaccinated. Childhood vaccination at intermediate levels of coverage (70% and 60% for first and second dose coverage respectively) is expected to lead to an increase in adult varicella. At high coverage (90% and 80% coverage) this is unlikely to be the case. These results will be used to inform a cost-effectiveness analysis of combined varicella and zoster vaccination programmes.”

I do not think 20 is a magic number.  But it does seem that now, about 16 years after introduction of the VZV vaccine in wide use, we are seeing serious epidemiological problems with it.  This knowledge is already changing people’s opinions about the wisdom of universal VZV vaccination.  20 is a ballpark.  And since in your initial post you *completely ignored* the cited problem, which is increased Herpes Zoster rates, and you stated that there were not any problems, let alone ones that would materialize in the next four years, and cited a wiki for Pete’s sake.

These are your words:  “So, can you tell me what complications we can expect in the next 4 years here in America that haven’t turned up in the previous 16 years of usage, or 20 years of usage in Japan as I just cited in my second link?” 

You are wrong.  Complications have shown up.  I did not look specifically for Japanese studies, but if you understand the links I posted, you can see that it is a serious problem.  My ballpark of 20 years doesn’t mean there is something magical, like I said, it is a ballpark.

And the overall point is that vaccinating isn’t always even best for the herd.  We are sacrificing the old in our herd right now for the young.  Is it possible we could eradicate the disease, and it would change in time?  Perhaps.  Is it possible that herpes zoster issues in the elderly are trumped by the saved lives of children?  Possibly.  But we don’t have that data yet, and I would like to see it since we now know that there is a serious problem with how the vaccine is changing herd immunity.

the first abstract I posted said that vaccinating the elderly wouldn’t completely solve the problem:

At high coverage (90% and 80% coverage) this is unlikely to be the case.

Which argues for high coverage, IMHO.

That’s why I posted the excerpt about the Zoster vaccine, which I think, based on the available evidence, should solve that problem.

You are wrong.  Complications have shown up.

I didn’t deny any existed, so saying I’m wrong when I asked for information is such a good way to make your point.

But it does seem that now, about 16 years after introduction of the VZV vaccine in wide use, we are seeing serious epidemiological problems

Did you know that the CDC has been monitoring this situation since 1994?:

Results

Decline in cases
In 1995, there were 2934 verified cases reported in Antelope Valley, CA, 3130 cases in Travis County and 1197 cases in West Philadelphia. The number of cases declined in all sites in 1996 and remained stable until 1998. In 1999, the number of cases began to dramatically decrease and in 2000, there were 837, 491, and 250 cases in Antelope Valley, Travis County, and West Philadelphia respectively. Between 1995 and 2000, the total number of cases in the three surveillance areas declined 71% to 84%, with the most considerable reduction in preschool children (1-4 year olds). By 2005, the number of cases declined by about 90% in both Antelope Valley and West Philadelphia combined.

In 1995, there were 2934 verified cases reported in Antelope Valley, CA, 3130 cases in Travis County and 1197 cases in West Philadelphia. The number of cases declined in all sites in 1996 and remained stable until 1998. In 1999, the number of cases began to dramatically decrease and in 2000, there were 837, 491, and 250 cases in Antelope Valley, Travis County, and West Philadelphia respectively.

Decline in hospitalizations

There were 28 to 42 hospitalizations between 1995 though 1998 for all sites, which decreased to 3 hospitalizations in 2004 and 5 hospitalizations in 2005. Hospitalization rates ranged from 2.2 to 3.3 per 100,000 population from 1995 to 1998 and decreased to 0.5 per 100,000 in 2004 and 0.8 per 100,000 in 2005. From the results of the National Hospital Discharge Survey (NHDS), the annual varicella-related hospitalization rates have declined to 0.12 hospitalizations per 10,000 U.S. population during 2000-2006 compared to a rate that exceeded 0.42 hospitalizations per 10,000 U.S. population from 1988 to 1995.

Decline in deaths

From data provided by the National Center for Health Statistics (NCHS), the number of deaths with varicella listed as an underlying cause has declined 78%, decreasing from 0.41 deaths per 1,000,000 in 1990-1994 to 0.14 in 1999-2001. The greatest reduction in mortality rates occurred among children aged 1 to 4 years.

Increase in vaccination coverage

Vaccination coverage has increased for children between the ages of 19 and 35 months since 1997. In Los Angeles County, vaccination coverage increased from 37.9% in 1997 to 91.8% in 2009. In Philadelphia, vaccination coverage increased from 41.2% in 1997 to 91.3% in 2009. A similar increase in vaccination coverage seen from the VASP sites is reflected nationally: from nation-wide data, vaccination coverage in children aged 19-35 months increased from 25.8% in 1997 to 89.6% in 2009.

if you understand the links I posted, you can see that it is a serious problem.

Listen,you dumb shit

And the overall point is that vaccinating isn’t always even best for the herd.  We are sacrificing the old in our herd right now for the young.  Is it possible we could eradicate the disease, and it would change in time?

(cont)

Sacrificing?

Are you out of your mind, given the available data to date?

This is from last year:

The recent data on zoster incidence in vaccinees suggest that the risk is lower than among those with a history of varicella. However, long-term follow-up of vaccinated, healthy children will be required to provide detailed data on risks throughout the life span. Studies of herpes zoster incidence in the future, when vaccinated children are older adults, are likely to provide useful information.

To date, only one of four studies has shown an increase in zoster incidence after varicella vaccination in the United States. While it is plausible that a sufficient number of varicella exposures can reduce the risk of zoster in select populations, it remains unclear whether such levels of exposure play an epidemiologically important role in reducing the risk of zoster among the general population of older adults who are at the highest risk of the disease and, if so, how long such effects would last in the elderly. Persons living or interacting with children may have different underlying health conditions compared to persons without exposure to children, which may be a confounder in these studies. This issue is also complicated by the introduction of a zoster vaccine that reduces the risk for developing zoster by 50% in persons ≥60 years of age. Even modest coverage levels with this vaccine could substantially mask other trends in zoster incidence, particularly if its use is recommended for younger persons (50 to 59 years of age).

Finally, the limitations of currently available diagnostic techniques for ascertaining vaccine-modified cases of varicella are a problem requiring urgent attention, since accurate evaluations of efforts to quantify vaccine impact will critically rely on better tools than are available now.

http://cmr.asm.org/cgi/content/full/23/1/202

This is from WHO:

Childhood immunization with lower coverage could theoretically shift the epidemiology of the disease and increase the number of severe cases in older children and adults.

The justification for vaccine control

Except for vaccination, no countermeasures are likely to control the dissemination of varicella or the frequency of zoster in a susceptible community. Varicella-zoster immune globulin and antiherpesviral drugs are very costly, and mainly applied for post-exposure prophylaxis or the treatment of varicella in persons at high risk of severe disease. Due to its extremely contagious nature, varicella is experienced by almost every child or young adult in the world. Each year from 1990 to 1994, prior to availability of varicella vaccine, about 4 million cases of varicella occurred in the United States. Of these cases approximately 10 000 required hospitalization and 100 died. Although varicella is not commonly perceived as an important public health problem, the socioeconomic consequences in industrialized countries of a disease that affects practically every child and causes the carer to be absent from work should not be underestimated.

The recently marketed varicella vaccines have been shown to be safe and effective. From a societal perspective, a recent cost-benefit analysis in the United States showed that routine chickenpox vaccination is likely to save five times the investment. Even when only direct costs were considered, benefits almost balanced the costs. Similar studies from developing countries are not available. However, the socioeconomic aspect of varicella is likely to be of less importance in countries with a different social organization. On the other hand, the public health impact of varicella and zoster may be increasing in regions with high rates of HIV endemicity.

It is not yet sufficiently documented that the varicella vaccine, administered either in childhood or in adult populations, will protect against zoster. However, several indications, including the results of vaccination studies in certain immunodeficient groups, are encouraging in this regard. The public health as well as the socioeconomic impact of this vaccine would increase drastically if it was proved to protect against zoster in the general population. In industrialized countries considerable amounts are spent on medical care in complicated cases of zoster in immunocompromised or elderly persons, and the increasing incidence of zoster in HIV-affected areas is well documented.

oldfeminist,

If there is anything substantive you said that I did not respond to, point me to it, and I will.

It was an ad hominem.  You used it as an insult, you did not explain *why* defending an individualized cost benefit analysis for new vaccines was bad.  It was meant to discredit, not to defeat any argument I was making.  So, textbook ad hominem.

Comment #77: Ismone on 09/25 at 05:53 PM

Defending an individualized cost benefit analysis for new vaccines can be selfish.  Some folks think this is fine.  I don’t, because the illness of someone else is something I should concern myself with even if it doesn’t personally affect me.

But you took it one further.  You didn’t respond to the argument that you walking around before you are symptomatic can get other people sick. 

You either don’t believe that this is true or you don’t care.

Hence self-centered.

old feminist,

I did respond to that argument.  See my comment 54.

Dark Avenger,

To take things one at a time, despite your unwarranted bad manners and oversimplifications:

1)  Regarding how this supposedly will not be a problem with “high coverage” of 80-90%—this is speculation, there is no data on that yet.  What we do know, is right now, herpes zoster is on the rise because of the VZV vaccine.

2)  Regarding complications—if you did not mean to suggest there were no complications, your statement, which I quoted, was poorly written.  If you meant to suggest there were no “new” complications, I also do not understand your point.  We are getting additional data, and the more data we get, the more cases of herpes zoster we are seeing among unvaccinated older people.  The studies so far suggest that sadly, vaccinating these people won’t take care of all of those cases.  We do not yet know what will happen to them—if they will die from the disease later, for one.

3)  Regarding the CDC allegedly monitoring the situation—you are either confusing or deliberately eliding children having chicken pox with adults having herpes zoster.  There would be a time delay between children getting vaccinated and adults getting herpes zoster.  So a snapshot right after vaccination starts measuring both reponses to the virus doesn’t really address the issue.  That is why longitudinal data is so important.  And that is why your study shows a decrease overall, and the studies I cited showed an increase in herpes zoster.  The last CDC data you cite is from 2001.

4)  The first study you quote in your comment 82 is completely speculative.  It is stating what the current decline is, and acknowledges that the authors do not know what will happen when the vaccinated children age.  Considering the fact that we are seeing more effects the longer it has been since vaccination, the fact that only “one in four” studies show an increase is not that shocking.

5)  Yeah, theoretically.  That is why I want more data.  BECAUSE WE DO NOT KNOW YET IF THE VACCINE DOES MORE GOOD THAN HARM.

despite your unwarranted bad manners and oversimplifications:

if you understand the links I posted, you can see that it is a serious problem.

You assumed that if I didn’t agree with you it’s because I don’t understand anything.

Gee, that’s not insulting nor a case of bad manners as well, thanks for explaining things so well.

1)  Regarding how this supposedly will not be a problem with “high coverage” of 80-90%—this is speculation, there is no data on that yet.  What we do know, is right now, herpes zoster is on the rise because of the VZV vaccine.

Again:

To date, only one of four studies has shown an increase in zoster incidence after varicella vaccination in the United States.

2)  Regarding complications—if you did not mean to suggest there were no complications, your statement, which I quoted, was poorly written.  If you meant to suggest there were no “new” complications, I also do not understand your point.  We are getting additional data, and the more data we get, the more cases of herpes zoster we are seeing among unvaccinated older people.

I obviously meant the latter, and your assertion isn’t backed up by the scientific literature to date.(2010)

Which is why only 25% of studies demonstrate your assertion to be the case.

So a snapshot right after vaccination starts measuring both reponses to the virus doesn’t really address the issue.  That is why longitudinal data is so important.  And that is why your study shows a decrease overall, and the studies I cited showed an increase in herpes zoster.  The last CDC data you cite is from 2001.

Uh, there is ongoing monitoring, from the CDC link:

Currently, only Antelope Valley (implemented by the Los Angeles County Health Department) and West Philadelphia (implemented by the Philadelphia Department of Public Health) project areas are under surveillance.

Increase in vaccination coverage:
Vaccination coverage has increased for children between the ages of 19 and 35 months since 1997. In Los Angeles County, vaccination coverage increased from 37.9% in 1997 to 91.8% in 2009. In Philadelphia, vaccination coverage increased from 41.2% in 1997 to 91.3% in 2009. A similar increase in vaccination coverage seen from the VASP sites is reflected nationally: from nation-wide data, vaccination coverage in children aged 19-35 months increased from 25.8% in 1997 to 89.6% in 2009.

So, the data doesn’t end at 2001, as you stated it did.

Yeah, theoretically.  That is why I want more data.  BECAUSE WE DO NOT KNOW YET IF THE VACCINE DOES MORE GOOD THAN HARM.

From the WHO LINK:

The recently marketed varicella vaccines have been shown to be safe and effective. From a societal perspective, a recent cost-benefit analysis in the United States showed that routine chickenpox vaccination is likely to save five times the investment. Even when only direct costs were considered, benefits almost balanced the costs. Similar studies from developing countries are not available. However, the socioeconomic aspect of varicella is likely to be of less importance in countries with a different social organization. On the other hand, the public health impact of varicella and zoster may be increasing in regions with high rates of HIV endemicity.

Dark Avenger,

You still have not demonstrated that you understand, or even acknowledge that the increase in herpes zoster is a serious problem.  Instead, like in this comment, you keep disingenuously referring to early studies that show immediate decreases in both the chickenpox and the herpes zoster form of the disease.

You keep ignoring the evidence that shows that hepes zoster is now on the rise. 

Your additional data only has to do with vaccine coverage past 2001.  It does not discuss infection rates.

The WHO link is not considering the long-term effects of vaccines on herpes zoster rates.  Which we do not yet know, but which we have an inkling of.

So in short, you keep quoting studies that are from quite a while ago, don’t have any relevant recent data about herpes zoster infection rates, or don’t separate it out at all.

The studies I have cited are more recent, and show that there is an increase.  They even explain why the increase happens.

The reason I think you are arguing in bad faith is because you are not engaging *at all* with the studies I have cited that undermine your point, and keep citing the same articles which I have already shown the weakness of.

I honestly don’t understand how you can be doing that if you understand the data I have posted.  Your data is not as good, and I have repeatedly explained why. 

You haven’t even bothered to post the WHO link, and a WHO position paper is not the same as a peer-reviewed study.

Instead, like in this comment, you keep disingenuously referring to early studies that show immediate decreases in both the chickenpox and the herpes zoster form of the disease.

How is a study from 2010 an ‘early study’?

You keep ignoring the evidence that shows that hepes zoster is now on the rise.

You have one study that can be cited as evidence, and the researches I cited found only 1 study that supports your POV, and 3 that do not.

They even explain why the increase happens.

Declining primary varicella (chickenpox) disease among children may lessen natural boosting of immunity to varicella zoster virus in adults and increase their risk of herpes zoster.

The WHO link is not considering the long-term effects of vaccines on herpes zoster rates.  Which we do not yet know, but which we have an inkling of.

To date, only one of four studies has shown an increase in zoster incidence after varicella vaccination in the United States.

The reason I think you are arguing in bad faith is because you are not engaging *at all* with the studies I have cited that undermine your point, and keep citing the same articles which I have already shown the weakness of.

You’ve shown only one study that demonstrates a measurable effect.  Own it.

I honestly don’t understand how you can be doing that if you understand the data I have posted.  Your data is not as good, and I have repeatedly explained why.

What data? Your first article was about what was ‘expected’, the other a single study contradicted by 3 other studies which was mentioned in a peer-reviewed paper from 2010.

and a WHO position paper is not the same as a peer-reviewed study.

Except when it appears in a peer-reviewed periodical:

This chapter was last published as a WHO position paper: Varicella vaccines: WHO position paper. Weekly Epidemiological Record, 1998, 73:241–248,

And this is from 2007:

Herpes zoster is not a nationally notifiable disease in the United States, and HZ surveillance has been conducted using multiple methods, study sites, or data sources. For certain studies, baseline data were available before the start of the varicella vaccination program. One study that included baseline data was a retrospective analysis of electronic medical records from a health maintenance organization (HMO) during 1992—2002 (60). This HMO study indicated that age-adjusted incidence of HZ remained stable during 1992—2002 as incidence of varicella decreased (60). Age-adjusted and -specific annual incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was highest in 1992, at 4.1 cases per 1,000 person-years, and was 3.7 cases per 1,000 person-years in 2002. For other studies initiated in the postvaccine era, baseline data are not available (61—63). An analysis of national incidence data from the Medstat database (available at http://www.medstat.com/Products/view/?id=71) demonstrated an overall incidence of HZ in 2000 and 2001 of 3.2 (95% confidence interval [CI] = 3.1—3.2) per 1,000 person-years (61), representing no increase in age-adjusted HZ in the past 20 years in the United States compared with earlier published data (64). Data from two HMOs in Oregon and Washington for 1997—2003 indicated no statistically significant increase in HZ incidence rates except among children aged 10—17 years (relative risk [RR] = 1.12, CI = 1.05—1.18); these increases were attributed to increased use of oral steroids (62). Another study of data gathered from a statewide telephone survey during 1999—2003 in Massachusetts demonstrated an increase in HZ (63). Age groups particularly affected included persons aged 25—44 years and those aged >65 years. Finally, in the two active varicella surveillance sites (Antelope Valley, California, and West Philadelphia, Pennsylvania), active surveillance for HZ in children aged <20 years has been ongoing since 2000. During 2000—2004, incidence of HZ in children aged <10 years declined significantly (p<0.05) from 0.75 to 0.23 cases per 1,000 children (65; CDC unpublished data, 2006). In summary, multiple studies and surveillance data demonstrate no consistent trends in HZ incidence in the United States since implementation of the varicella vaccination program in 1995.

CDC Link