Saturday, December 19, 2009

More about the Chasidic Mumps Epidemic


Last Friday's post, I regret to say, had some serious errors in it, errors that made the mumps epidemic currently taking place in Hasidic Borough Park and Hasidic Monsey seem much less severe then it actually is.

More after the jump


Before I confess my own sins, let me address two common errors I've seen on my own threads and elsewhere.  Many are saying that this isn't mumps, or that its some new strain of the disease. They support the claim that this isn't mumps by pointing out that many immunized people have come down with the disease. How would a vaccinated person contract mumps they wonder. The explanation is simple. The mumps vaccine is not fool-proof. It has a success rate of 72 - 91 percent (last Friday I misstated the success rate as 90 percent. I have been corrected by three different doctors.) This means that occasionally vaccinated people will come down with the mumps, and this is what has happened.

Those who say that this is some new strain of mumps support their claim by saying that blood tests for the disease have came back negative. This is true and can be easily explained. Like the vaccine, the mumps blood test is not fool-proof. If it is administered during the first few days of symptoms it will sometimes come back negative, and this has also happened. Moreover, we know that this is not a new strain because (per my doctor friends who work in Borough Park and Monsey and are regularly seeing cases of mumps) the CDC has cultured some positive cases and identified it as the "g" strain of mumps, which is the same strain of mumps that turns up in any outbreak.

Now, let me address some of the errors I made in the first post.

When I posted on Friday, I assumed the CDC statistics took into account every case of mumps. For instance, I assumed that when the CDC said that 25 cases were reported at the camp where the outbreak began, this meant that only 25 children had contracted the disease. The truth is the CDC statistics only include confirmed cases. As noted above, a mumps test administered early in the disease will sometimes come back negative for mumps even if the patient clinically had the disease. These results are not included in the CDC statistics. Also, some parents don't bother bringing their infected children to the doctor - especially if the child's pain can be managed and the swelling isn't very noticeable, or if they know their child (like his friends) has mumps and that nothing can be done (Compare with chicken pox: Not every case makes it to a doctor).

Finally, first world doctors, as a rule, are not familiar with mumps. One physician friend who says he's diagnosed over 100 cases of mumps since October admits that before the first case arrived he'd never seen it. As this friend explains, when a first world doctor sees a swollen neck, mumps isn't the first thing that comes to mind. He might test for it, but probably won't - and anyway, if the test comes back negative (see above) and the doctor doesn't know what mumps looks like he might not make the diagnosis. Of course, these missed diagnosis are also not reported by the CDC.

So, when the CDC says Borough Park had 61 cases by mid-October, what this really means is that there were 61 cases in Borough Park that were reported to a doctor, were diagnosed correctly and produced positive blood tests. In reality, there were many more then 61 cases in Borough Park by mid-October, and in the month and change since the CDC's report there have been hundreds and hundreds more - in Borough Park and Monsey, in particular, but also anywhere this sect of Hasidim travel, including Montreal and NJ.

As I reported (correctly) on Friday, the immunization rate in this particular Hasidic community hovers around 40 percent, which means a great many of them are susceptible to the disease, and because 9 - 28 percent of vaccinated people are also susceptible to the disease (see above) anyone who comes into contact with this community is also at risk  Remember, the incubation period for mumps is about 21 days, which means an infected person has almost three weeks to spread the disease everywhere he goes - in buses, in schools, and in medical waiting rooms.  The danger is real, and as I said on Friday, some of the blame must rest with the rabbis associated with this sect of Hasidim. These leaders will order their flocks to embrace stringencies, and to make sacrifices for Torah, but to date, they have not ordered their followers to immunize their children. This is inexplicable.

See the Journal News article from Saturday: http://www.lohud.com/apps/pbcs.dll/article?AID=2009912190331

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