October 22, 2008
Kenneth Stoller, M.D.
International Hyperbaric Medical Association
404 Brunn School Road, #D
Santa Fe, New Mexico 87505
Dear Dr. Stoller:
Thank you for your information quality request for correction dated May 5, 2008, and amended on May 25, 2008. We provide the following responses to your comments and questions.
Regarding the Centers for Disease Control and Prevention’s (CDC) statement, “These cases and outbreaks resulted primarily from failure to vaccinate, many because of personal or religious belief exemption,” CDC has the following response:
Exemptions for school vaccination requirements pertain only to children attending schools or colleges and, in some states, to children attending child care centers. Exemptions do not apply to infants who are too young to be vaccinated (less than 12 months old), children 12 to 15 months of age (since they are within the age group for which the first dose of Measles Mumps Rubella [MMR] vaccine is recommended, and exemptions generally apply to children older than the age at which measles vaccine is recommended), or adults. Therefore, we calculated the percentage of exemptions from vaccination only for children who were 16 months to 19 years of age. In this age group, 14 of 21 case-patients (67%) claimed exemptions. The CDC statement concluding that the cases and outbreaks resulted primarily from failure to vaccinate was descriptive of the data available. Although this fact sheet is not currently posted in the public domain, CDC will ensure that this calculation is clearly presented and described should it be publicly disseminated in the future. While we acknowledge that infants younger than 12 months and children 12 to 15 months of age for whom the first dose of MMR vaccine is recommended cannot be classified in this category, none of these children were primary cases in an outbreak; they were all infected through exposure to others who were age-eligible for vaccination but were unvaccinated.
Regarding the CDC statement, "Before the measles vaccination program, about 3–4 million persons in the U.S. were infected each year, of whom 400–500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis,” CDC has the following response:
Because measles is highly infectious, before the availability of measles vaccine almost every person in the United States contracted measles and showed evidence of immunity when their blood was tested.1 The CDC estimate of 3–4 million cases of measles per year prior to the estimate of 400–500 deaths is based on the average number of measles deaths reported in the United States from 1950–1962; during this period there were an average of 475 measles-related deaths reported in the United States each year.2
The estimated measles-related hospitalizations and chronic disabilities are based on 1963 data from the United Kingdom that provided U.K. rates of serious complications from measles.3 These estimates are based on the assumption that the U.S. population had similar rates of measles-related hospitalizations and complications during this time.
Regarding your statement, “The CDC's one-size-fits-all, no-exceptions MMR vaccine policies allow almost no contraindications to MMR vaccine use,” CDC has the following response:
CDC advises in the Vaccine Information Statement for MMR vaccine that the following groups of persons not get vaccinated: People who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or to a previous dose of MMR vaccine. People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting MMR vaccine. Pregnant women should wait to get MMR vaccine until after they have given birth. Women should avoid getting pregnant for four weeks after getting MMR vaccine. Some people should check with their doctor about whether they should get MMR vaccine, including anyone who: has HIV/AIDS or another disease that affects the immune system; is being treated with drugs that affect the immune system, such as steroids, for two weeks or longer; has any kind of cancer; is taking cancer treatment with x-rays or drugs; or has ever had a low platelet count (a blood disorder). People who recently had a transfusion or were given other blood products should ask their doctor when they may get MMR vaccine (available at http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mmr.pdf).
In addition, you might find the recent CDC update about the 2008 U.S. measles cases and outbreaks of interest (Update: Measles—United States, January–July 2008. MMWR. 57;893-896. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm).
We hope that these explanations answer your concerns. If you wish to appeal this response to your request for correction, you may submit a written appeal or electronic request for reconsideration within 30 days of receipt of our response. The appeal must state the reasons why the agency response is insufficient or inadequate. You must attach a copy of your original request and the agency's response to it. Also, clearly mark the appeal with the words, “Information Quality Appeal” and send the appeal to the following address:
Centers for Disease Control and Prevention
Management Analysis and Services Office
1600 Clifton Road, N.E., Mailstop E-11
Atlanta, Georgia 30333
Fax: (404) 929-2781
Electronic submission: http://www2.cdc.gov/PublicInquiry/PIAppealForm.asp?theID=35
Anne Schuchat, M.D.
Rear Admiral, U.S. Public Health Service
Assistant Surgeon General
Director, National Center for Immunization and
Centers for Disease Control and Prevention
1 Langmuir AD. Medical importance of measles. Am J Dis Child. 1962;103:54-56.
2 Bloch AB, Orenstein WA, Stetler HC, et al. Health impact of measles vaccination in the United States. Pediatrics.
3 Miller DL. Frequency of complications of measles, 1963. Br Med J. 1964;2:75-78.