Oh look: South Dakota's #2... in measles!

Measles map, New York Times, February 2, 2015

Measles map, New York Times, February 2, 2015.(Click to embiggen!)

Asterisk our #2: four of the cases mapped around Mitchell are folks from other states inflating our numbers.

I heard Senator Rand Paul on NPR yesterday saying he's not against vaccinations but that "it is an issue of freedom" for parents choosing how to take care of their children.

I'd tell Senator Paul that choosing not to vaccinate your kids is like choosing to smoke in the house while your kids around. You have the freedom to make that choice, but it's a stupid choice, based with few exceptions on ignorance and selfishness. And you're not making that choice in some remote Galt's Gulch utopia; you're making that choice here, in real society, surrounded by real people whose lives your choice will negatively impact.

Go ahead, exercise your freedom. But keep your cigarettes and your measles-prone children away from my child.


Let me give credit where credit is due. Governor Dennis Daugaard has dedicated his first column of the new year to telling the anti-vaccine crowd that the resurgence of measles is their fault, that they are wrong on science and social responsibility, and that they need to get their shots:

Avoiding vaccination has been a recent trend. As the memory of these diseases fades into the past, too many people seem to forget the risk of not vaccinating children. Unsubstantiated and discredited theories about side effects have created unreasonable anxiety. Medical professionals, repeated scientific studies and organizations such as the American Academy of Pediatrics agree that vaccination is vital and safe.

I recognize that there are extreme circumstances where a child may not be able to receive specific vaccines because of a severe allergy or condition. In South Dakota, we also allow people to forgo a vaccination for religious reasons. But for the overwhelming majority of people, vaccines are safe and reliable.

Not vaccinating doesn’t just affect you and your kids. It puts others at risk as well. Just as the polio vaccine protected millions of children from disease in the 1950s, vaccines save lives today. Vaccination is just as necessary today as it was decades ago [Gov. Dennis Daugaard, "Vaccinating Saves Lives," press release, 2015.01.02].

This KSFY graphic leaves me wondering whether we've got measles or a chocolate allergy.

This KSFY graphic leaves me wondering whether we've got measles or a chocolate allergy.

I've razzed the Governor, just a little, for not raising the alarm about the anti-vaccers threat to public health. Now he's done just that. Thank you, Governor!

By the way, before the weekend, the Department of Health confirmed nine cases of measles in Mitchell, all in the same extended family, none vaccinated, and none of the children in public school.


Last summer, Governor Dennis Daugaard expressed concern that the 21 vaccinated and screened child refugees placed in South Dakota posed a health risk to our fair state. Governor Daugaard should have been more concerned about the health risk posed by local yokels not getting their shots. Thanks to the vaccination paranoia promoted by certain members of the Governor's party, such shot-resistors have brought South Dakota its first measles outbreak since 1997:

According to health officials, the six people that have been diagnosed with the virus are in Davison County, and are made up of three adults and three children. The children range from under the age of five all the way to teenagers.

Health officials say they are all part of an extended family that came together for a holiday celebration. None of them are vaccinated against the measles.

...Several other people are showing symptoms and are being closely monitored. The state is also in contact with about 50 other people who may have been exposed to the virus [Rachel Skytta, "Six Confirmed Cases of Measles in SD," KDLT-TV, 2014.12.31].

South Dakota actually leads its federal Health and Human Services region in MMR vaccination rates at 93.1%. The national rate is 91.1%. Our neighbors in Minnesota are only at 90.8%. (Michele Bachmann is apparently infectious.) Think of those numbers this way: if one of those infected Davison County anti-vacciners walked through the food court at the Mall of America and sneezed a few times, he could have infected one out of eleven people.

The state Department of Health says measles causes brain damage in one out of a thousand cases and death in three out of a thousand cases. SDDoH says measles is highly contagious and can spread by direct contact or by airborne droplets. It is thus less deadly but more contagious than Ebola, which had Senator John Thune calling for a big-government travel ban to prevent the remote possibility of that disease spreading. Fellow blogger Larry Kurtz wonders why Thune is not now calling for a travel ban on Mitchell, but that wondering expects of our Senator logic and consistency, things to which Republicans have developed a strong herd immunity.

The Affordable Care Act has required insurance companies to cover vaccines for four years. The measly Davison County family could have taken advantage of their health plan to get their shots at no additional costs. Instead, they've chosen to become a hazard to people with allergies or compromised immune systems (like kids with leukemia undergoing chemotherapy) who cannot get the MMR shot.

Vaccination rates have been declining nationwide based on no solid scientific evidence of vaccine harms. At the same time, outbreaks of measles and other diseases for which we have vaccines are rising. We can go back to the bad old days when nearly everyone got measles, or we can knock off the vaccine paranoia and get our shots.

And for now, put off that trip to the Corn Palace.

Related Reading: Alas, I'm probably just making matters worse: recent research shows that public health messages promoting vaccines and efforts to debunk anti-vaccine myths only strengthen parents' resolve not to vaccinate their kids. There's just no communicating with some people. Might as well ship them to the FEMA camps....


We all fled here from somewhere.

According to the Office of Refugee Resettlement, the federal government placed 30,340 immigrant children who entered the United States without adult companions with sponsors around the country between January 1 and July 7 of this year. 21 of those children were placed with parents, relatives, or other legitimate sponsors in South Dakota. Governor Dennis Daugaard expresses concern—not for the children, but for the natives' health and welfare:

“It is disappointing that, despite assurances from federal officials, these children have been placed in South Dakota without notification to the state,” said the Governor. “Although federal officials indicate that these 21 children have been screened and vaccinated, we will be asking for more information so that the state can be sure that these children pose no risk to South Dakotans” [South Dakota state government, press release, 2014.07.25].

Governor Daugaard has touted South Dakota's relatively high vaccination rate, but between 1% and 2% of our kindergartners are still running exempt from shots. Governor Daugaard has raised no alarm about the ability of a parent to skip vaccinating her kids by signing a piece of paper saying Jesus told her not to get those shots (see SDCL 13-28-7.1). Let's see... 13,280 kindergartners, multiply by 1%... that's 133 kids running around without shots. And that's just one grade. If we're running a 1% vaccine-skipping rate through all of our 144,000-strong K-12 population, we can estimate about 1,440 South Dakota kids posing a risk to South Dakota's herd immunity.

The Office of Refugee Resettlement gives children shots and medical screenings, and it does not release children with contagious conditions. These new children boost South Dakota's herd immunity. They're probably so relieved to be safe with family and friends in a quiet, safe state like ours that they aren't thinking of posing a risk to anyone. South Dakota should be proud to provide these children safe haven and invite more of them and their families to make our great state their home.


Now I know why Birchy conservatives really hate the Affordable Care Act: it requires insurance companies to cover vaccines!

"Payment has always been a big barrier to making sure children are properly protected against those preventable diseases," Sanford Clinic Chief Medical Officer Dr. Dan Heinemann said.

Dr. Heinemann says while it will cost insurance providers initially to pay for the vaccines, hopefully it will save money in the future by preventing diseases.

"When you prevent illnesses, downstream you reduce costs because people aren't sick," Heinemann said.

Here are just a few of the vaccines that are now covered under the Affordable Care Act: Hepatitis A and B, measles, mumps and rubella and the human papillomavirus.

"Clean drinking water and vaccinations are two of the hallmarks of public health and why we've been able to reduce the number of illnesses, especially in children," Heinemann said [Casey Wonnenberg, "Vaccines Covered under Affordable Care Act," KELOLand.com, 2013.10.02].

Some South Dakota conservatives will tell you all those shots are just some government plot. When Sanford, Avera, and Rapid City Regional hospitals require their employees to get flu shots to protect the health of their customers, some of my Facebook acquaintances complain about the unjust infringement on worker rights (which suddenly matter when defending the right to resist public health measures but not when defending the right to unionize and fight for better pay). And HPV? Oh my: some conservatives will tell you that just means we'll have a whole bunch of women having sex without getting sick.

By the way, the ACA's coverage of vaccines isn't really news. The HHS info sheet Wonnenberg links at the bottom of her report (yes! Thank you, Casey! More reporters should do that!) reminds us that the ACA's vaccine coverage and other preventive care requirements kicked in three years ago. The Affordable Care Act has been doing good for over three years, and the Republic hasn't collapsed. Carry on!


I hear far too many of my conservative friends falling for the anti-vaccine fad. Don't be stupid: vaccines are not some insidious child-killing plot. Vaccines are, in the words of one molecular biologist working on a vaccine for malaria, "the single greatest invention of humankind." I give hyperlinks a close second... but hyperlinks didn't make 50 million annual cases of smallpox disappear.

Thankfully, South Dakotans in general aren't buying the anti-vaccine hysteria. The state Department of Health says our kindergarten immunization rates are among the highest in the nation:

The CDC surveyed immunization records for 12,468 South Dakota kindergarten students for the 2012-2013 school year and found:

  • 97.9% were fully immunized for MMR (measles, mumps, rubella);
  • 97.7% were fully immunized for DTaP (diphtheria, tetanus, pertussis);
  • 96% were fully immunized for varicella (chickenpox); and
  • just 0.3% had a medical exemption for vaccination and another 1.5% claimed a religious exemption.

“South Dakota parents and vaccine providers do a great job of getting kids the shots they need for school entry,” said Lon Kightlinger, state epidemiologist for the Department of Health. “These high vaccination rates prevent disease from spreading and protect people with medical conditions that keep them from getting vaccinated” [South Dakota Department of Health, press release, 2013.08.06].

Word, Lon! I don't like needles, but I know kids need those shots to beat down diseases and keep everyone healthy.


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