My husband had TB as a child.

I favor vaccinations.

The side-effects of the medication were life altering...not in a good way...

I learned a lot about public fear of that illness and what it means to be treated like Typhoid Mary.

Public health policy requires that the public be involved. Allowing individuals to opt out of vaccination programs for invalid reasons defeats the purpose of having a public health policy.

Generally, liberals are in favor of public health, so it's strange to see so many on an ostensibly liberal site like DU arguing against public health policy.

Like most Americans you didn't make that choice.

That's a choice that was made FOR you by people who contributed to public health policy.

But was it a GOOD decision for American public health? The Brits and much of Europe went the other way...was the US just led by a bunch of anti-science anti-vaccination types?

TB is an important disease in a world with international travel by jet aircraft. It's attack rate is similar to the measles in the US, not withstanding the Disney outbreak we are all worked up about

But the US went against vaccination. I think that was a rational decision, though I might have gone the other way, having had TB and having suffered through 'sterile bowel' syndrome from the anti-TB drugs.

and there's no way to tell the difference between someone who reacts positive because of the vaccine, and someone who tests positive because they're infected.

The US chose to follow a testing policy to identify and treat cases of TB when discovered, instead of population-wide vaccination.

This is an either or decision at the population level. You can chose one or the other, but you cannot control this disease with voluntary individual vaccination choices.

If half the population chooses to get vaccinated, how will you be able to tell those infected apart from those vaccinated?

You can't.

thanks.

Sid

But my adopted son who is from Russia had the TB vaccine there. When he went through the health check as part of the immigration process he tested positive for TB. No amount of explanation about having taken the vaccine helped. He had to go through a full course of treatment for TB as if he had the disease.

And he still has to carry an affidavit from the doctor that he is free of TB and has taken the full course of medication because anytime he is tested, he is going to show positive.

If you want to go through that hell you're welcome to it.

that I think the decision for US public health policy on BCG vaccine is rational.

People here can't see the forest for the leaves.

i.e. that vaccination causes autism.

Again, I must be missing your point. It appears that you are using the policy to not vaccinate for TB as a reason to allow parents to refuse vaccination for other communicable diseases.

It's entirely reasonable to vaccinate for some diseases, yet not for others. It's not reasonable to refuse vaccination because of discredited research.

then we should follow those guidelines.

I don't see any incongruence in vaccinating when recommended, and not vaccinating when it is not recommended.

I don't mean to undermine it in this case, because I think there is a rationale behind that decisions that makes sense.

But having worked in state public health at a professional level I have to say, blind trust in public health policy is not any better than blind trust in the legislative process.

Sometimes it gives ok results. Sometimes it doesn't.

That should be discussible. I think it's a good thing for citizens of a democracy to be engaged in decision making by bureaucrats as well as elected officials. In fact, I think it's essential. Not just because every viewpoint must be folded into policy, but because effective policy must be understandable to people and the contributions of concerned citizens goes a very long way in telling public health educators where the work is that they must do.

if their decision making is sound.

What we have are a vocal contingent, woefully ignorant of science, who are insisting that we make a decision - to allow voluntary non-participation in vaccination programs - based upon discredited research. The response should be "No - the evidence does not support such a decision."

If there were sufficient evidence to suggest otherwise, then a reevaluation would be warranted.

the doctor and nurses came to our school. It is the one I nearly passed out from watching it given. Both of my children received it.

I seriously almost didn't make it back to my desk after watching my skin bubble up as it was given. Made a vivid impression.

was grown from the original strain sent from France.

When you say bubble up it makes me wonder if you were vaccinated or whether you were given a skin test.

Typically only people in high risk professions are given vaccine in the US.

Which kind of proves your point.

Information isn't presented to us.

We don't always get choice.

We depend on procedures that balance ALL the risks, take into consideration ALL the points of view. And those procedures may not even take place during our lifetimes.

It's easy to kick people around because of fear or disgust because we see them as anti-science, but the reality is most of us are just as uninformed, we just put faith in different things.

I was required by the State of Arizona to endure a full day of x-rays, blood tests, and spit tests every six months until I turned 18, when I left the state. The next month, the Michigan Dept. of Health knocked on my door, and declared me a public health threat. I was informed that unless I took every single pill in the bottle of medicine they gave me, I would be forcibly deported from the state. I took every one of those 365 pills, which were supposed to guarantee that I could never catch TB, and that was over 45 years ago.

Then, when I was hospitalized 3 years ago with pneumonia, they freaked out over my family history, put me in isolation and ordered the TB skin test. It came back negative, which really, really pissed them off, but I was pleased more than words can say. No, haven't had that vaccine, they say I CAN'T.

he grew up on a farm. TB in cattle was pretty common in the teens and twenties of the last century.

My father turned up positive on routine screening required because he worked for the school district. The entire family then was asked to get xrays. I did the lung x-ray thing at a mobile facility it was negative. (How many people remember TB x-ray trailers in shopping market parking lots?)

I skin converted on a test about 4 months later and went on two drugs, a version of isoniazid labeled "hyzyd" and rifampin. Truly awful side-effects that even after I completed taking the pills left me sick for many months as the bacterial flora of my intestines struggled to achieve community balance.

This was in Arizona, where many people with TB came because doctors thought the dry hot weather would cure them. Maricopa County had several sanitoriums where the sickest were sent, and where my mother spent the last few years of her life. They placed us in quarantine for 30 days the day after her funeral. The word Tuberculosis still strikes terror in me, over 60 years later.

the first 3 months were chemical treatment, then he had the upper quadrant of his right lung removed and the remainder of the time was spent in recovery from that.

TB was a huge fear for his generation. He was very depressed about it's emergence in his body. He had had a sense that he had escaped its danger many years before...

My understanding is that for non-resistant TB, hospitalization/placement in a sanitarium isn't prevalent anymore.

"Just why is a low occurrence of illness an argument against vaccinating against drug resistant TB but not acceptable as an argument against vaccinating against measles?

The TB vaccine is about 60% effective and was developed in 1908. We need a new one. Since 2005 about 15 new TB vaccines have been tested in more than 50 clinical trials. Over the next decade, large scale clinical trials will provide safety and efficacy data and hopefully, a first generation vaccine to prevent TB will be available. The works is being done, but it's slow. Eventually there will be a more effective vaccine that can make an impact in preventing infection.

The measles vaccine is about 90% effective. It's safe and it works and there's no reason to not receive it.

Trying to compare use of the TB vaccine vs. the measles vaccine through race is flawed.

The current TB vaccine isn't.
In addition, TB is much less infectious than measles.
Most people exposed to it don't even get sick and don't spread it to others.

this black and white bullshit that presumes goodness is screwy Manacheanism.

Because it doesn't make sense - READ why.

BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity. The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert.

http://www.vaccines.gov/diseases/tb/

Also,

"TB vaccination called BCG is not indicated for everyone...
It is not 100% effective. Rather only about 50% of individuals who received vaccination are protected and almost 80% are still suceptibe to infection but with weaker response."

http://www.justanswer.com/health/1dtpm-long-tb-vaccinations-last-often-person.html

Also, there's a huge difference in transmission. The R0 number (http://en.wikipedia.org/wiki/Basic_reproduction_number) tells you how transmissible a virus is. If it's <0, that means the infection will die out. Hell, Ebola is only 1.5-2.5, and requires contact with bodily fluid. Measles is a whopping 12-18, and is an airborne transmission. TB has a difficult to calculate, cumulative R0 (because of relapse as well as transmission after initial infection which can be a fast or slow form of the disease) but it's somewhere around 5 (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.129.9834&rep=rep1&type=pdf).

Pretty basic. Measles is more contagious that TB. The Measles vaccine has high effectiveness, and the TB vaccine has really crappy effectiveness. Measles vaccine causes no problems with diagnosis, while TB vaccine negates the best test. All of which is why the TB vaccine is used in more selective groups based on actual likelihood of infection.

So let's not start arguing false equivalencies. There's a very good reason for the different vaccination guidelines.

slightly different data and no one can explain why the differences exist

Currently the first listed reason for NOT vaccinating everyone in the US is low prevalence of TB. But low prevalence is actually slightly more than that of measles...for which everyone IS argued to be vaccinated.

The decisions of the US was not in line with much of the rest of the developed world.

As a nation we are anti-BCG TB vaccination. As I have said repeatedly throughout this thread, there is a rational for that. A rational that wasn't accepted by other countries' public health policy.

And it must be said the situation isn't 'settled'. Rather nations review and change their vaccination policies. Time changes understanding, perspectives, and priorities even for public health policy makers.

The black and white "with us or against us" silliness on DU about all vaccination is really a poor substitute for understanding and over the course of the past 24 hours it's gotten pretty much involved with calls for excommunication that would be worthy of the Mormon church.

because the environments are different.

India has one of the highest rates of TB. That nation alone accounts for approximately one-quarter of all the TB infections in the world.

Studies show that the efficacy rates of the BCG vaccine to be anywhere from 0 to 80%. A large trial study in southern India failed to indicate any protection overall.

But, with that said, the BCG does appear to mitigate the most serious and deadly forms of TB infection in *Children*. So, the BCG vaccine is part of routine childhood vaccination programs in *India* and other low-income nations with high rates of infection.

Comparing other nation's policies to US policies is also comparing apples to oranges.

http://www.cdc.gov/mmwr/preview/mmwrhtml/00054407.htm

There is no real comparison.

Isn't that a curiosity, that should challenge black and white thinking?

Effectiveness is based on serology. Rising titres being the historic demonstration. Based on that it's been estimated from as low as 20 percent to around 90 percent. Very curiously people in the 48 contiguous states and people in India show less rise in antibody titre.

No one is exactly certain why that is. There is a working hypothesis that it comes from the presence of other mycobacteria in the US and India which interfere with the efficacy testing. The effectiveness may be higher than what is suggested by the test.

Moreover, even in the US vaccination is 70% effective in preventing the emergence of tubercular disease even when give to people post exposure.

So efficacy isn't simple to consider, either.


This thread really isn't about measles vs TB it's about how understanding public policy and private concerns around vaccination really isn't at all as black and white as many DUers think.

What is your point?
Everybody should be loaded up with inefficient vaccine for TB?
Nobody should be loaded up with efficient vaccine for measles?
I am confused.

I'm sorry your view of the forest seems to be blocked by trees.

let me try to push aside some vegetation...once again this ISN'T ABOUT MEASLES VACCINE VS TB VACCINE


It's about making people think about what they assume.

Most people know very very little about the rationales that exist for vaccine public policy. They think they know more...or they think they can simply trust others to make good decisions for them. The latter is a VERY strange position for DU which always knows better from attacking foreign countries to whether or not a run or a pass play should end a superbowl.

It's reductive to absurdity to assume vaccination is all good or all bad.

It's likewise Manachean to suggest that anyone who expresses a concern on a losing side of current policy is an evil antisocial devel intent on killing you or your relatives.

I think TB is an excellent starting place for people to begin reading about information that went into policy making in developed nations. Policy that resulted in the US taking a position not only unlike that of neighboring western nations, but that was in contradiction to the World Health Organization...for rational reasons.


And THAT is the point. Rational people, not nuts and not idiots, can look at policy needs and come to different conclusions for their constituents...allowing those constituents to rest on their laurels ignorant of potential different outcomes that should be regularly revisited.




Public health

When somebody comes up with an efficient vaccine, the policy could very well change.
But you can't protect people against diseases that don't have effective vaccine.
Measles is not one of those diseases.

and that varies geographically resulting in different public health authorities making different decisions.

The point, which is too obvious to be grasped apparently, is that EACH vaccine operates different, in different circumstances and MUST be evaluated as such.

Consequently it's possible to be pro some vaccines and anti others.

OH how hard is that? It's not black and white.

It just isn't.

So do the folks arguing for rational approaches get banned or do they pass the litmus test?

Actually, I don't like litmus, and prefer bromthymol blue if you could, make that green vs yellow rather than red vs blue...

So exactly what is your point? You basically asked why people aren't getting the TB vaccine. It is not generally recommended in the U.S. That's why. Asked and answered.

I actually remember the initial TB skin test and then the intradermal vaccination a couple weeks later. I haven't looked for the scar in years, I think it was my left deltoid but it's awkward for me to look for it at present. I wonder if it has disappeared. I hope I remember to look when I get home tonight! In any event, I'm sure my immunity is gone by now-- if I recall correctly, bacilli Calmetter-Guérin only confers TB immunity for a few years, and was never particularly good for pulmonary TB.

Just curious.

If I'm not mistaken, I believe we lived in Fredrick, Maryland, but we lived in many places during my early childhood, so that's ultimately just a guess. Also, I received significant portions of medical treatment in my mother's home town, in Georgia. But the clarity of the memory makes it seem to have been about that time, for which I have many clear memories. It's where we lived when JFK was killed. I was in second grade there, and I think we lived there a couple of years, in all.

Which is why it isn't widely used.

So I worked on my immunity with the real thing.

Admittedly, it means I have to get chest x-rays now, instead of the Mantoux skin test, which is a bit irritating.

since yesterday. It's this week's hot topic. Next week, it will be something else, and you won't be able to get away from it. Rape, or Olive Garden, or obesity.

Peace.

new. They had to go through 6 months of antibiotics treatment. I don't remember much about it. However, I think that my sister would have had her children and herself vaccinated years before since she is not an anti-vaxer and they often traveled overseas to visit family. They were exposed and needed to go through the "treatment" anyhow.