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11th December 2014, 12:24 PM
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Traverse City disease outbreaks show threat of undervaccination
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An outbreak of pertussis, also known as whooping cough, forced Grand Traverse Academy in Traverse City to close for a week. (Julie Mack | MLive.com)
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Julie Mack | jmack1@mlive.com By Julie Mack | jmack1@mlive.com
on December 11, 2014 at 5:15 AM, updated December 11, 2014 at 8:54 AM
TRAVERSE CITY, MI -- Over the past six weeks, the Traverse City area has become an unnerving, real-life example of the consequences of undervaccination.
Cases of whooping cough and measles have impacted hundreds of families, overwhelmed local doctors and public health officials, and put parents who don't vaccinate their children on the defensive.
"Nobody likes to be the person who says, 'I told you so,' " but what's unfolding now is exactly the scenario feared by those worried about the region's low immunization numbers, said Dr. Bradley Goodwin, a Traverse City family physician who is president of the Grand Traverse County Medical Society.
Grand Traverse County has one of Michigan's highest rates of schoolchildren opting out of vaccines -- twice the state average and six times the national rate for kindergartners in 2013-14.
In some schools, the rate is even higher. That includes Grand Traverse Academy, the 1,200-student charter school associated with the initial outbreak of whooping cough, also known as pertussis, an illness nicknamed "the 100-day cough."
grand traverse academy, pertussis, whooping cough, vaccinations, immunizationsAmy Ettawageshik hold 2-month-old son, Ty, as he receives a round of immunizations, including one for pertussis. Ettawageshik has five older children, some of whom attend Grand Traverse Academy, which was experiencing an outbreak of whooping cough and Ettawageshik wanted to protect her newborn against the disease.Julie Mack | MLive.com
A teacher at Grand Traverse Academy was diagnosed with whooping cough on Oct. 16. Once introduced into the school community, the disease took off. To date, a total of 151 confirmed and probable cases of whooping cough have been linked to the school.
One reason the illness swept through the academy: A significant number of its students are unvaccinated. In 2013-14, 17 percent of Grand Traverse Academy kindergartners had parents who signed a waiver exempting their children from the required childhood immunizations.
"When you have (pertussis) spread so fast through a school community with high waiver rates, that's not coincidental," Goodwin said.
Also fueling the outbreak: When the teacher was first diagnosed, students classified as "close contacts" were told to take antibiotics as a preventive measure, but not all followed the directive, said Wendy Trute, health director for the Grand Traverse County Health Department.
Some parents didn't want to give antibiotics to children who don't seem sick. But whooping cough is contagious before symptoms appear.
"Two families didn't get or take antibiotics, and they account for eight or nine of the confirmed cases," Trute said. "People not following through (with medical directives) is one of the issues."
The school had so many cases of whooping cough that school officials canceled the elementary fall carnival as well as four days of classes. While the school was shuttered, the 1,200 students were told to stay at home in quarantine to prevent spreading the disease further.
That was the second week of November. Since then, whooping cough cases have been reported at 14 other school buildings across the region and new cases are still coming in, Trute said.
Last week, as Trute and her staff were still dealing with whooping cough, two county residents turned up with measles -- considered the most contagious disease known to man and one more prone to serious complications than pertussis. Three more cases were confirmed this week in neighboring Leelanau County, involving people who had contact with the first two patients.
Measles "is so contagious that if someone with measles went into a waiting room where nobody was vaccinated, 90 percent of the people in that room would get measles," Trute said.
The quarantine period for an unvaccinated "close contact" of a measles patient is 21 days, compared to five days for whooping cough.
One good aspect of measles: Two doses of the measles vaccine last a lifetime and are highly effective in immunizing an individual against the disease.
By comparison, while pertussis is less contagious than measles, its vaccine also is less effective -- it requires a booster shot every 10 years and some people immunized against pertussis can develop the illness, albeit in a milder form.
Trute said about a third of the pertussis cases in the Traverse City area involve people who are vaccinated.
Particularly vulnerable have been children around age 10 or 11, because the immunizations they received in infancy are wearing off and they haven't yet had a booster shot. It didn't help that the outbreak at Grand Traverse Academy started in the upper elementary grades, Trute said.
Still, it's clear that unvaccinated children were those most at risk.
A state epidemiologist ran the numbers for the Traverse City pertussis outbreak and calculated that children who aren't vaccinated have been five times more likely to come down with pertussis than those who have been immunized, Trute said.
Hundreds affected
It's been a brutal six weeks for the Grand Traverse County Health Department.
Trute said her staff has stepped up to the challenges of responding to the outbreaks, but they're working long hours and giving up their holidays and weekends to keep pace. That includes dealing with 1,500 phone calls received on a pertussis hotline established a month ago.
The health department and local physicians aren't the only ones scrambling.
VACCINATION DATABASE
Search our statewide databases for students who have been vaccinated or were granted waivers, by school, district and/or county.
Even beyond the confirmed cases of diseases, hundreds of families have been affected -- from quarantine orders, to tracking down the prophylactic antibiotics, to getting booster shots, to keeping kids home from school and staying clear of church, stores and other public places for fear of contracting a nasty and highly contagious illness around the holidays.
"People can be overly cautious, like not wanting their kid to go to school, but I've also seen a lot of legitimate concern," Goodwin said.
Among those impacted has been Amy Ettawageshik, a Grand Traverse Academy parents with six children under age 12, including an infant.
Infants are particularly susceptible to pertussis and 50 percent of babies who catch the disease need to be hospitalized.
To be on the safe side, Ettawageshik brought her 2-month-old son to the health department for a pertussis vaccine, even though he was a little young for the first round of shots.
The outbreak also meant she had to track down antibiotics for the older children, even though they were fully vaccinated, and keep them away from others for several days.
"I tend not to get too frightened," Ettawageshik said. But, "I have a lot of kids, and I don't want them infecting anybody else."
New normal?
The whooping cough outbreak has become a hot-button issue in Traverse City, pitting parents who vaccinate their children against those who don't, said Beth Milligan, a reporter for The Ticker, a Traverse City news website.
"People on the pro-vaccination side are very angry at the anti-vaxers for exposing their children to disease," Milligan said.
Meawhile, "the anti-vaxers are latching onto the fact" that some fully vaccinated people are getting whooping cough, which they say proves their point that vaccinations are ineffective, Milligan added.
"A lot of people who don't vaccinate don't see the need," said Milligan, who wrote an in-depth story in September about the county's low vaccination rate. "Many are families who are into holistic medicine," and feel there are better ways to build the immune system and ward off disease.
The problem with that thinking, Goodwin said, is that unvaccinated people are much more likely to spread disease compared to those who are immunized, even if the unvaccinated people don't appear sick.
"I'm a big believer in better living through better living," Goodwin said. "But while your immune system is fighting off an illness, you can still be contagious and infect others, and those others may not be as healthy as you."
If anything, Trute said, the fact the pertussis vaccine is not 100 percent effective is all the more reason to maintain high immunization rates, to prevent the disease from getting a foothold in the community.
Her fear, she said, is that what's happening this year will become a semi-regular event in Grand Traverse County.
"This is going to be our new normal if we don't get our vaccination rates under control," Trute said.
Time for change?
The question going forward is whether the uproar and disruption associated with the pertussis and measles cases will create community change in Traverse City.
"It's certainly helped raise awareness on how quickly disease can spread," Goodwin said. "I think there was a sense of complacency about how serious these diseases can be. For an adult, a 100-day cough is an inconvenience, but for an infant, it can be fatal.
"It's also helping people to reconsider and re-evaluate their stance against vaccines," Goodwin added. "Most people are seeing now that there is a value to getting vaccines, and realizing their previous premise about going without being vaccinated was overzealous."
Trute agreed there has been a "fair amount of conversation" in recent weeks about trying to reduce the number of schoolchildren with vaccination waivers.
"A lot of people are becoming vocal now because it's effecting them," she said. "I do think it's possible that once we get through this craziness, there will be a call to positive action."
Some educators are thinking the same way. Susan Wagner-Dameron, director of Grand Traverse Academy, said it is important to remain respectful of parents who choose not to vaccinate their children. But she is also thinking of hosting an immunization clinic at the school next year.
Meanwhile, The Children's House, a Montessori school in Traverse City, which also had a student with whooping cough, has been educating parents on the value of vaccinations.
"I don't think you're ever going to change the minds of some people," Trute said. "We're trying to affect people on the fence."
Milligan agreed that some opposed to vaccinations are "digging in their heels," but recent events are changing attitudes on vaccinations.
"When you're faced with a highly contagious outbreak, it creates a lot of fear and that fear can be a useful catalyst," Milligan said. "Sometimes you need something scary to happen to realize the consequences of not vaccinating."
Julie Mack is a reporter for MLive.com. Contact her at jmack1@mlive.com.
Traverse City disease outbreaks show threat of undervaccination
grand-traverse-academy
An outbreak of pertussis, also known as whooping cough, forced Grand Traverse Academy in Traverse City to close for a week. (Julie Mack | MLive.com)
Julie Mack | jmack1@mlive.com By Julie Mack | jmack1@mlive.com
on December 11, 2014 at 5:15 AM, updated December 11, 2014 at 8:54 AM
TRAVERSE CITY, MI -- Over the past six weeks, the Traverse City area has become an unnerving, real-life example of the consequences of undervaccination.
Cases of whooping cough and measles have impacted hundreds of families, overwhelmed local doctors and public health officials, and put parents who don't vaccinate their children on the defensive.
"Nobody likes to be the person who says, 'I told you so,' " but what's unfolding now is exactly the scenario feared by those worried about the region's low immunization numbers, said Dr. Bradley Goodwin, a Traverse City family physician who is president of the Grand Traverse County Medical Society.
Grand Traverse County has one of Michigan's highest rates of schoolchildren opting out of vaccines -- twice the state average and six times the national rate for kindergartners in 2013-14.
In some schools, the rate is even higher. That includes Grand Traverse Academy, the 1,200-student charter school associated with the initial outbreak of whooping cough, also known as pertussis, an illness nicknamed "the 100-day cough."
grand traverse academy, pertussis, whooping cough, vaccinations, immunizationsAmy Ettawageshik hold 2-month-old son, Ty, as he receives a round of immunizations, including one for pertussis. Ettawageshik has five older children, some of whom attend Grand Traverse Academy, which was experiencing an outbreak of whooping cough and Ettawageshik wanted to protect her newborn against the disease.Julie Mack | MLive.com
A teacher at Grand Traverse Academy was diagnosed with whooping cough on Oct. 16. Once introduced into the school community, the disease took off. To date, a total of 151 confirmed and probable cases of whooping cough have been linked to the school.
One reason the illness swept through the academy: A significant number of its students are unvaccinated. In 2013-14, 17 percent of Grand Traverse Academy kindergartners had parents who signed a waiver exempting their children from the required childhood immunizations.
"When you have (pertussis) spread so fast through a school community with high waiver rates, that's not coincidental," Goodwin said.
Also fueling the outbreak: When the teacher was first diagnosed, students classified as "close contacts" were told to take antibiotics as a preventive measure, but not all followed the directive, said Wendy Trute, health director for the Grand Traverse County Health Department.
Some parents didn't want to give antibiotics to children who don't seem sick. But whooping cough is contagious before symptoms appear.
"Two families didn't get or take antibiotics, and they account for eight or nine of the confirmed cases," Trute said. "People not following through (with medical directives) is one of the issues."
The school had so many cases of whooping cough that school officials canceled the elementary fall carnival as well as four days of classes. While the school was shuttered, the 1,200 students were told to stay at home in quarantine to prevent spreading the disease further.
That was the second week of November. Since then, whooping cough cases have been reported at 14 other school buildings across the region and new cases are still coming in, Trute said.
Last week, as Trute and her staff were still dealing with whooping cough, two county residents turned up with measles -- considered the most contagious disease known to man and one more prone to serious complications than pertussis. Three more cases were confirmed this week in neighboring Leelanau County, involving people who had contact with the first two patients.
Measles "is so contagious that if someone with measles went into a waiting room where nobody was vaccinated, 90 percent of the people in that room would get measles," Trute said.
The quarantine period for an unvaccinated "close contact" of a measles patient is 21 days, compared to five days for whooping cough.
One good aspect of measles: Two doses of the measles vaccine last a lifetime and are highly effective in immunizing an individual against the disease.
By comparison, while pertussis is less contagious than measles, its vaccine also is less effective -- it requires a booster shot every 10 years and some people immunized against pertussis can develop the illness, albeit in a milder form.
Trute said about a third of the pertussis cases in the Traverse City area involve people who are vaccinated.
Particularly vulnerable have been children around age 10 or 11, because the immunizations they received in infancy are wearing off and they haven't yet had a booster shot. It didn't help that the outbreak at Grand Traverse Academy started in the upper elementary grades, Trute said.
Still, it's clear that unvaccinated children were those most at risk.
A state epidemiologist ran the numbers for the Traverse City pertussis outbreak and calculated that children who aren't vaccinated have been five times more likely to come down with pertussis than those who have been immunized, Trute said.
Hundreds affected
It's been a brutal six weeks for the Grand Traverse County Health Department.
Trute said her staff has stepped up to the challenges of responding to the outbreaks, but they're working long hours and giving up their holidays and weekends to keep pace. That includes dealing with 1,500 phone calls received on a pertussis hotline established a month ago.
The health department and local physicians aren't the only ones scrambling.
VACCINATION DATABASE
Search our statewide databases for students who have been vaccinated or were granted waivers, by school, district and/or county.
Even beyond the confirmed cases of diseases, hundreds of families have been affected -- from quarantine orders, to tracking down the prophylactic antibiotics, to getting booster shots, to keeping kids home from school and staying clear of church, stores and other public places for fear of contracting a nasty and highly contagious illness around the holidays.
"People can be overly cautious, like not wanting their kid to go to school, but I've also seen a lot of legitimate concern," Goodwin said.
Among those impacted has been Amy Ettawageshik, a Grand Traverse Academy parents with six children under age 12, including an infant.
Infants are particularly susceptible to pertussis and 50 percent of babies who catch the disease need to be hospitalized.
To be on the safe side, Ettawageshik brought her 2-month-old son to the health department for a pertussis vaccine, even though he was a little young for the first round of shots.
The outbreak also meant she had to track down antibiotics for the older children, even though they were fully vaccinated, and keep them away from others for several days.
"I tend not to get too frightened," Ettawageshik said. But, "I have a lot of kids, and I don't want them infecting anybody else."
New normal?
The whooping cough outbreak has become a hot-button issue in Traverse City, pitting parents who vaccinate their children against those who don't, said Beth Milligan, a reporter for The Ticker, a Traverse City news website.
"People on the pro-vaccination side are very angry at the anti-vaxers for exposing their children to disease," Milligan said.
Meawhile, "the anti-vaxers are latching onto the fact" that some fully vaccinated people are getting whooping cough, which they say proves their point that vaccinations are ineffective, Milligan added.
"A lot of people who don't vaccinate don't see the need," said Milligan, who wrote an in-depth story in September about the county's low vaccination rate. "Many are families who are into holistic medicine," and feel there are better ways to build the immune system and ward off disease.
The problem with that thinking, Goodwin said, is that unvaccinated people are much more likely to spread disease compared to those who are immunized, even if the unvaccinated people don't appear sick.
"I'm a big believer in better living through better living," Goodwin said. "But while your immune system is fighting off an illness, you can still be contagious and infect others, and those others may not be as healthy as you."
If anything, Trute said, the fact the pertussis vaccine is not 100 percent effective is all the more reason to maintain high immunization rates, to prevent the disease from getting a foothold in the community.
Her fear, she said, is that what's happening this year will become a semi-regular event in Grand Traverse County.
"This is going to be our new normal if we don't get our vaccination rates under control," Trute said.
Time for change?
The question going forward is whether the uproar and disruption associated with the pertussis and measles cases will create community change in Traverse City.
"It's certainly helped raise awareness on how quickly disease can spread," Goodwin said. "I think there was a sense of complacency about how serious these diseases can be. For an adult, a 100-day cough is an inconvenience, but for an infant, it can be fatal.
"It's also helping people to reconsider and re-evaluate their stance against vaccines," Goodwin added. "Most people are seeing now that there is a value to getting vaccines, and realizing their previous premise about going without being vaccinated was overzealous."
Trute agreed there has been a "fair amount of conversation" in recent weeks about trying to reduce the number of schoolchildren with vaccination waivers.
"A lot of people are becoming vocal now because it's effecting them," she said. "I do think it's possible that once we get through this craziness, there will be a call to positive action."
Some educators are thinking the same way. Susan Wagner-Dameron, director of Grand Traverse Academy, said it is important to remain respectful of parents who choose not to vaccinate their children. But she is also thinking of hosting an immunization clinic at the school next year.
Meanwhile, The Children's House, a Montessori school in Traverse City, which also had a student with whooping cough, has been educating parents on the value of vaccinations.
"I don't think you're ever going to change the minds of some people," Trute said. "We're trying to affect people on the fence."
Milligan agreed that some opposed to vaccinations are "digging in their heels," but recent events are changing attitudes on vaccinations.
"When you're faced with a highly contagious outbreak, it creates a lot of fear and that fear can be a useful catalyst," Milligan said. "Sometimes you need something scary to happen to realize the consequences of not vaccinating."
Julie Mack is a reporter for MLive.com. Contact her at jmack1@mlive.com.