The Worst Measles Outbreak In The European Union | Hacker News Reader

The Worst Measles Outbreak In The European Union

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40 pointsdsr1268 comments

I was close to a potential measles outbreak this summer. Close enough that had to be tested because my vaccination decades ago in another country was considered insufficient. (I was found to be already immune, as expected, but got a booster anyway.) I also got to work with epidemiologists who were working to contain things, and fortunately the outbreak did fizzle out . So I take this issue pretty personally.

Whatever people's concerns about vaccines might be, and I'll concede that manufacturers' lack of transparency about ingredients and adverse-reaction risks is part of the problem, those totally pale in comparison to the importance of maintaining herd immunity to prevent the disease itself from spreading. There are people who are too young to be immunized, or who have conditions that preclude it. Also, vaccines do fail. The current rate is around 2% and that's what led to the case I was involved in. There is a very small chance that someone will avoid problems that might have occurred if they'd had their children vaccinated. There's a much larger chance that in the process they'll put someone else's child at risk. It's stealing others' lives for their own, so I think it's quite reasonable to compare vaccine refuseniks to vampires. Don't be a vampire. Get your damn shots, make your sure children get their damn shots, and do your part to keep this killer from roaming around freely.

URL: https://www.youtube.com/watch?v=RfdZTZQvuCo&

Penn and Teller on Vaccinations. This really drives home the point of herd immunity ( in ~ 90 seconds ).

It's great to say "but what about the children" and all, but immunized individuals really don't need to involve themselves in the lives of those choosing to avoid medical treatment.

By definition, the immune won't be harmed by my choice to not immunize myself. If I get sick, and you are immune, my choice to take risks won't harm you.

If you're worried about those other than yourself, who might be harmed by my hypothetical decision to risk illness and injury, your advice should be phrased to them as an audience.

Meanwhile, the waters are still muddier. There are a wide array of other terrible personal choices that are defended maximally, despite conceptual harm being part of the package. The choice to consult a doctor, or not, the choice to not be resuscitated, to not seek treatment for terminal diseases, to not suffer treatment when quality of life is not rewarding.

All of these choices matter as much as choosing to have a child at all. Ultimately, I think some children would be better off as orphans in foster care, but I'm not about to try and make that happen. I think it's more about letting nature take its course.

The immune live. The others die. Darwin's theory prevails.

Some children are at an age when they are both too young to get vaccinated and too old to be protected by antibodies from their mother. They rely on herd immunity to not get infected.

Vaccinations don't always take, so some people who have been vaccinated are not immune and rely on herd immunity to not get infected.

Some people are immunocompromised and cannot take vaccinations and rely on herd immunity to not get infected.

If my quality of life is low, even while otherwise healthy, what do I care about the well-being of the herd?

If I'm held down, and made to work two or more low-paying jobs, and still can't escape poverty, you're going to have to hold me down even harder, and force me to take care of myself.

If I'm unhappy in life, I'm not going to see a doctor to keep that life going. Does this make sense yet?

That does make a point, but it's not what's happening here. You don't get to 30 years old before you decide to get vaccinated. You get them as young children.

Following your analogy it would be more like "I don't like my life, so I'm not going to take care of my children"

Also we do take steps to hold people down and make them take care of themselves or just do it ourselves, when it's gets so bad that they affect other people. If you let your home start collapsing it'll get condemned. If you let trash pile up on your property and attract dangerous animals into the neighborhood you'll get increasing fines until your forced to clean up. If you go into a drug fueled bender all the time and wander the streets attacking people, you'll be arrested.

This is just another case of people creating negative externalities that everyone else has to deal with, and then hiding behind the idea that personal freedoms mean they can do whatever they want without limit

Well, the argument goes something like: I'd euthanize my kids and spend the rest of my waking life in one of your jails, dying childless, rather than let them live in your world, raised by you, and not me.

If I'm in your jail, I'd rather dispell all illusions about it, and not live a life pretending my children are more than your playthings. Furthermore I wouldn't even want kids, if they'll be raised by you. They're better of dead or aborted.

Let's be clear, I'm playing devil's advocate, and I don't really think or believe this myself, but this is the root of the argument.

My reason for surfacing the foundation of the premise for such behavior, is because I think different strategies are needed to confront emerging biological hazards of the future.

It's not going to be enough to just ask people to jump on a band wagon, and it's barking up the wrong tree, to remove an individual's choice from the equation. People have to want to live, and biological epidemics have to be attacked with a variety of strategies.

Vaccinations are good, and so are antibiotics, but they won't save us in all cases, and they won't save all of us even when they do work.

Other brute force methods like area denial take over, when the sophisticated medical tactics fail. It's important to look ahead, and recognize that in scenarios where vaccines and antibiotics don't work, to consider the situations that emerge even when other plans fail.

Basically, the oldest option on the table is quarantine. It's low tech and appeals to biblical sensibilities. Some people are willing to try it instead. The argument is going to go that way. Strategies for dealing with people who think like that are going to have to chart a different course.

My actual position is that life sciences are going to radically change in the next decade or so, anyway. Why bother haranguing people about vaccinations, when five years from now, biological agents might very well be a solved problem, rendering vaccinations as obsolete as brute force quarantines?

> I'd euthanize my kids and spend the rest of my waking life in one of your jails, dying childless, rather than let them live in your world, raised by you, and not me.

Sounds like your idea is to reject society for ultimate freedom. However, you do not get to both escape its bonds of obligations yet also enjoy its benefits. Are you ready to give up everything? I invite you to ponder on the historical meaning of outlawry.

> My actual position is that life sciences are going to radically change

You're not a doctor or bio scientist, you have no basis to speculate about a solution to disease that makes immunisation superfluous.

> Why bother haranguing people about vaccinations, when five years from now, biological agents might very well be a solved problem

Because we need to fight measles now or people die needlessly.

>Furthermore I wouldn't even want kids, if they'll be raised by you. They're better of dead or aborted.

Ignoring the abortion aspect where theres arguments on both sides as to whether its killing a person or not, lets look at the rest of that.

You are saying that you don't want to live in a world where your choices are forced, but if you had to, you'd kill your kids rather then let them live in it? How is this logically consistent at all? The only thing I'm seeing out of your argument is that you believe you are the sole arbiter of right and wrong, and you can take peoples lives if that is your decisions

>My actual position is that life sciences are going to radically change in the next decade or so, anyway. Why bother haranguing people about vaccinations, when five years from now, biological agents might very well be a solved problem, rendering vaccinations as obsolete as brute force quarantines?

So just put our heads in the sands and not deal with any issue because "...five years from now, biological agents might very well be a solved problem?". People who didn't make the choice to not get vaccinated are dieing due to others choices _now_, so we should let that keep happening because it _might_ not be a problem in the future?

I get the whole individual freedom argument. I even agree with it. However, when your choices start affecting others, you are now guilty of the exact same problem you were accusing others of. You are making choices for other people

> If you're worried about those other than yourself, who might be harmed by my hypothetical decision to risk illness and injury, your advice should be phrased to them as an audience.

That's ridiculous. Those people are doing all they can, considering their conditions. It's the people who are not doing all they can, exposing others to danger so they can satisfy their own contrarian "smarter/greener than everyone else" self-image, who need the message.

> There are a wide array of other terrible personal choices that are...

...irrelevant. That's just concern trolling.

> The immune live. The others die. Darwin's theory prevails.

Victim-blaming and concern trolling were bad enough, but now we're into eugenics. If you want to talk about "terrible personal choices" that should make the list.

You're using a lot of internet argument buzz words, but none of them invalidate my position.

More to the point: people get to make choices. That's what being a person means.

Either you let people choose, or you put them on a feedlot, admit that this is a factory farm, and openly ply them with antibiotics and horomones, so you can milk them longer, before putting the bolt gun to their head and serving their remains at McDonald's.

> Either you let people choose, or you put them on a feedlot, admit that this is a factory farm, and openly ply them with antibiotics and horomones, so you can milk them longer, before putting the bolt gun to their head and serving their remains at McDonald's.

How about the third option; let people do as they please, as long as it doesn't negatively affect others?

You're dismissing the concept of herd immunity, as well as the fact that there are people who can't be vaccinated for legitimate reasons (i.e age or medical issues), and the fact that vaccines aren't 100% effective, as "internet argument buzz words". It almost sounds like you're arguing either in bad faith or from a position of willful ignorance.

Pure anarchy or factory farming of humans.

Thank you for making us aware that those are the only two options for a society. The issue is much clearer now

Using your own logic, we should let healthy people choose to execute those who aren't immunized the instant they contract disease. It's self-defense, just let people choose.

Obviously that's absurd. There is a line drawn in any civil society, to keep it civil. If people want to opt out of immunizations, it should be legal and obligatory to eject them from society: they do not get to go to school in public schools, they can be discriminated against in hiring, they can be excluded from health care programs whether private or public insurance - until they comply. That is absolutely civil behavior, and it's reasonable. And they can still choose whether to participate in civil society or not.

And we have very nearly that policy. But the problem in the U.S. is religious exemptions. The flaw with the current coddling of religious folk, is that a person's right to religious freedom cannot be permitted to increase the risk to other people's lives. And yet it does, and we tolerate it so far.

The only people who should be exempt from immunizations are those who are immune compromised in a way that their life is at greater risk by being immunized.

This isn’t how immunizations work. Look up herd immunity. These things can and will fail. They don’t make you invulnerable.

> By definition, the immune won't be harmed by my choice to not immunize myself. If I get sick, and you are immune, my choice to take risks won't harm you.

This is not the same as talking about the immunised vs the non-immunised. In that case the statement is simply not true.

Better source: http://www.balkaninsight.com/en/article/fatal-inaction-how-m...

> In France, for instance, 41 percent of those surveyed said vaccines are not safe — more than three times the global average of 12 percent.

That’s a pretty astonishing statistic

Well, it's because of the government that once lied to the population on this subject. And, here we think that the vaccine is not safe, but the benefits are worth the small risk. But there is also a bunch of idiots thinking it's better to not get vaccinated and don't vaccinate their childrens.

"Well, it's because of the government that once lied to the population on this subject."

Can you elaborate on this? It's a strong claim and I'd be interested to know exactly what you mean.

Generally vaccines are fairly safe, however the government has created numerous incentives for their to be a lack of accountability, thus its to be expected that safety will fall over time. Specifically, they made it illegal to sue vaccine companies (making it so you must go to special vaccine court with predefined minimal damage awards).

Have you ever wondered why you see "get your vaccine shots" at every grocery you go in to? Its precisely because its almost risk free for big pharma. Those that have permanent or fatal reactions have little recourse.

Imagine trying to create a startup company whose business model was you were injecting strangers with some substance you created and your pitch was "we can just inject this into everyone at the local Walmart"...think that idea would get past the lawyers? Easy to do if you get congress to pass laws saying you will be held harmless.

Here is the original paper where the statistics about vaccination sentiment come from:

“The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey”

https://www.sciencedirect.com/science/article/pii/S235239641...

In 2009 Franch Governement allowed to bypass mandatory checks for the H1N1 flu vaccine and it made a lot of controversy. A lot of people remember the controversy today, and are suspicious.

https://en.wikipedia.org/wiki/Vaccine_controversies#Swine_fl...

The link you've posted doesn't include anything about the government allowing the vaccine to bypass mandatory checks. It just says there was a controversy about its potential safety. You need to link to something that backs up your main claim.

But they're not safe. Like any kind of medication, there's a risk of hidden effects or bad reaction that could and do happen. Rather than trying to lie, I think it's better to be honest about the possible side effects, and communicate about the nasty diseases we don't have to deal with thanks to those vaccines. Most anti-vaccines are stuck on the possible danger of vaccine, and aren't balancing it with all the benefits that come because we forgot how bad those diseases were.

The risk is something on the order of 1 child per million dies (or gets a lasting severe outcome, IIRC). That's ~4 children per year in the US, traded for the lives of millions.

Calling them safe is an abstraction that simplifies the conversation. Seat belts are meant to keep you alive at all costs. Often they're very damaging. But calling them unsafe muddies the conversation.

The biggest danger that the anti-vaxxers focus on, autism supposedly caused by vaccines, is based on a discredited paper published by a now-discredited researcher. It has no basis in fact.

No one is denying that there is a chance of a bad reaction or side effects. Safety is always relative, and vaccination is a lot safer than non-vaccination.

A few months ago, I heard people in the break room at work - educated software engineers in Silicon Valley - saying the same thing and nodding their heads sagely. It was hard for me to say something in opposition without losing my temper or insulting anyone.

Not really. "Safe" is a feeling. Unless you define it in some study as a % risk of something bad happening, it is not defined. It is similar to saying that 41 percent of those surveyed felt some uneasiness about taking vaccines. That does not seem really astonishing.

One should be a bit nervous when putting things in your body that are strange enough to change your immune system. Doesn't mean you shouldn't get over those feeling and get you and your kids vaccinated. Maybe this anti-vax movement is largely sustained by the "follow you feelings, reason will fool you" philosophy that seems to be ascendant at the moment.

The anti-vax movement as well as some of the things going on around genetically modified good or even just plain old organic foods frequently remind me of the anti-vax technology couple that Pirsig starts his motorcycle trip with in "Zen and the art of motorcycle maintenance". There are so many things all around us that most people don't understand and people are overwhelmed and tired from it resulting in this somewhat delusional pushback against modernity. We are building nostalgia and longing for a past that never existed because we don't want to have modernity which also isn't as esthetically pleasing as the made up, idyllically past.

An issue that there is alternative fear truths spreading on the internet as they are real facts when they are not.

With vaccines a majority of the population need to be vaccinated that prevents the disease from spreading.

https://en.wikipedia.org/wiki/Herd_immunity

Here is a graph of Measeles in the United states. Before and after vaccine. https://en.wikipedia.org/wiki/Herd_immunity#/media/File:Meas...

"Vaccine controversies have occurred since almost 80 years before the terms vaccine and vaccination were introduced. Despite overwhelming scientific consensus[1][2] that vaccines are safe and effective,[3] unsubstantiated scares regarding their safety still occur, resulting in outbreaks and deaths from vaccine-preventable diseases." https://en.wikipedia.org/wiki/Vaccine_controversies

https://en.wikipedia.org/wiki/Disinformation

The thing is, as a kid we got measles and we got time off school (Yay!), but we'd get a booster shot at the time and the wheels of society keep turning as we'd stay at home until we got well enough to go back. I got mumps, german measles and a variety of things kids nowdays get vaccinated for. I've had the chicken pox 3 times and it's relative, shingles, twice (somehow my immune system doesn't learn this one!).

So...why is there now all this fuss to be pre-vaccinated? To me it's like the tetanus shot, if you get pricked by a bit of rusty metal and it's been 10 years, you go and get a shot.

One of the main things that I can think of is that due to a modern society, both parents are working and absolutely need to send their kids to school. This of course can be a big problem without a mandatory, herd-immunity system in place.

> unsubstantiated scares regarding their safety still occur

This is probably because they're not exactly unsubstantiated:

- https://en.wikipedia.org/wiki/Pandemrix#Narcolepsy_investiga...

- https://www.abc.net.au/news/2010-11-23/the-fallout-from-a-ba...

What does "pre-vaccinated" mean in this context, exactly? Vaccinations only come in the "pre" variety; once you've caught the disease, vaccination is unlikely to do any good. Some diseases (e.g.: rabies) have a long enough incubation period that post-exposure prophylaxis is effective, but this is very much the exception.

Sure, kids can get measles, and they'll probably be just fine. Measles only has a 0.1%-0.2% mortality rate, after all... On the other hand, that means 1-2 of every 1,000 children who get the disease will die a completely pointless and preventable death.

https://text.npr.org/s.php?sId=669228140

Text version for us Europeans, blessed by GDPR.

Can't we just make it really @#$_ing inconvenient to decline vaccines? Bar kids from school and whatnot. Wouldn't this filter people who anti-vax only when it's convenient?

I have a sense that a lot of anti-vaxers would change their tone if it's actually inconvenient every day to be one. But I don't have the facts on this one and can't find anything with a short Google.

It would. I remember reading that something like this was enforced in some region (non-vaccinated kids couldn't go to school, I believe) and the vaccination rate jumped.

Yes, this is the approach in e.g. Belgium and Germany.

The gem is in the accompanying paper: https://www.ebiomedicine.com/article/S2352-3964(16)30398-X/f...

They are asking about safety and effectiveness, and in France there has been a debate about the HPV and Hep B vaccination, yet French children are still mostly properly immunized. The big European measles outbreaks happen in hardline Dutch Reformed communities.

> The big European measles outbreaks happen in hardline Dutch Reformed communities.

That's definitely not correct. Greece had the most cases of measles in the EU over the last year, at 3,049. France had 2,771. Italy had 2,599. Romania had 1,821. The UK had 1,019. Germany had 542. Slovakia had 471.

Ukraine had 23,000+ in just the first half of the year. That's not a problem with dutch communities.

The biggest outbreaks over the last 10-15 years in Europe have occurred in Ukraine, Bulgaria, Romania, Italy, France.

You can all thank Andrew Wakefield, the physician that published the fraudulent paper that linked vaccines to autism.

"Immunization rates in Britain dropped from 92 percent to 73 percent, and were as low as 50 percent in some parts of London."

Then he directed a documentary against vaccination, making things even worse.

Easy to solve - just calculate the economical and moral expenses of the outbreak, split them between all anti-vax proponents and make them pay.

What would you write down as the exact monetary value of a human life? How do you arrive at that number?

Ask an actuary

The same way any large policy maker does. This is a recurrent theme in social science, as you have to make big decisions such as whether it's worth spending an extra billion dollars on a slightly safer bridge.

https://en.wikipedia.org/wiki/Value_of_life

I don't know if that feels entirely applicable. People who advocate that people shouldn't vaccinate their children simply increase the chance of large amounts of people dying from preventable disease; if they didn't, nothing would've been lost. Calculating how much should be spent on a bridge, on the other hand, is simply necessary in a world where there is demand for bridges even though there's not enough resources to ensure that both enough bridges are built, and that every single bridge is guaranteed to be 100% safe.

Here you go: https://en.wikipedia.org/wiki/Value_of_life

In general the term refers to the cost of reducing the average number of deaths by one.

In US it would be little bit less than 10 million dollars.

Of course there is no such number. But there is a standard law practice and other methods of calculating this value, for the cases of moral compensation or safety/emergency decisions. The same rules can be applied here.

There is lots of research and literature about that. In the West, it's generally somewhere between 250k and 2mm.

I'll use this as an opportunity to plead for some rebuttal to the anti-vaxxers' arguments. My wife doesn't want to vaccinate our child so this very personal. She's highly educated, knows statistics and reads research papers, but is now convinced by the arguments of this movement. The thing is that no debunking source I've found on vaccines does much to address their arguments, which include, but are not limited to:

* the profit incentive of the vaccine manufacturers

* herd immunity being questionable

* dangerous substances in the vaccines (mercury)

* the effectiveness of vaccines at all being in question

* the decline of disease mainly being due to better sanitation and conditions rather than vaccines

The whole autism thing is really a minor part of it. There are many arguments backed up by various cherry-picked research articles or spread by a few anti-vaxxing doctors and even previous researchers, just like with global warming.

What I need is some rebuttal, that is not by some random blogger, that addresses all their concerns without treating the anti-vaxxer as a high-school dropout stay at home mom. At this point the problem is much wider than a few uneducated people spreading nonsense.

Edit: interesting that I'm getting hammered with down-votes. If you're down voting, is it because this is too personal, off topic or what? I think the answer to my question can be very helpful to others facing similar situations.

Well, there's these visualisations about polio and measles in the United States, which are very compelling for the last two points.

http://www.randalolson.com/2016/03/04/revisiting-the-vaccine...

Better sanitation as a reason would lead to cutoff lines to be not so sharp and to be around the same time for most diseases. I guess. So this throws serious doubt on better sanitation being a reason for decline in diseases.

That is very useful, thank you

How is the effectiveness in question?

The argument goes something like: there are outbreaks in populations with very high immunization levels, so they're not even effective! Or they're only effective for a time and only partially, so it's not worth the risk.

Interesting that in a way this might be a self-feeding cycle. People stop vaccinating, suddenly there are outbreaks in high-vaccination areas (really just smaller groups of people that do not vaccinate?), which then gets used as an argument against vaccinations.

To me, the effectiveness is the single most obvious argument for vaccinations. If that can't convince someone, maybe nothing can't.

If the eradication of smallpox isn't enough to convince your wife that vaccines are effective, then I don't think anything will convince her.

I don't think it's any single point that dominates their belief, but it's that they have so many "doubts" about vaccines to point to. As soon as you debunk one they move on to the next. In the end, even if you debunk all of them carefully, just the fact that there are so many "doubts" seem to fool the human brain into thinking things are not so clear. It's the same thing with global warming. The one dissenting scientist weighs the same as 10,000 on the other side. Or there's always the case from the past where the lone wolf scientist was right all along!

I'm hoping with enough good arguments and data I can sway her view, but I also know the human mind is incredibly bad at rational thought and interpreting statistics.

The list of "concerns" you post indicate that you and/or your wife in fact have not read the literature or understand the statistics involved. If you had, you'd surely know that very few vaccines have contained mercury for a long time. You'd know that even though mercury in some forms and doses can be harmful that doesn't necessarily extend to all forms or doses (as is the case for almost all chemicals). Do you also go out of your way to avoid other sources of mercury - areas near or downstream of gold mines, some fish and shellfish, some electronic equipment? Or is your "concern" limited to (usually non-existent) mercury in vaccines? Studies of herd immunity from either the mathematical or epidemiological perspective are trivial to find. Saying it's questionable is like saying "teach the controversy" about evolution or climate change.

It's hard to see any good intent here. Given the tactics already in wide use among anti-vaxxers, I'm not going to rule out the possibility that this is less about a sincere search for strong arguments than about taking the opportunity to repeat a series of already discredited anti-vax tropes.

I think it's pretty clear from my post that I do not believe those arguments. I'm asking how to debunk them because I'm a software engineer, not a biologist or doctor. I do not have the time nor competency to read research papers in medicine. I think it would be very useful if there was some trustworthy source that put together all the facts, debunking anti-vaxxing all together, all at once.

Thimerosal in vaccines (which it mostly isn't): https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.... https://www.nvic.org/faqs/mercury-thimerosal.aspx

Herd immunity: https://thoughtscapism.com/2015/04/20/the-simple-math-of-her...

Effectiveness of vaccines: https://medium.com/@visualvaccines/graphic-proof-that-vaccin...

It's no accident that measles outbreaks have started to recur in the US, with a very strong correlation to rates of vaccine refusal. California is a good example; multiple outbreaks there have been directly linked to the prevalence of parents abusing the "personal belief" exemption to refuse vaccinations. The OP here is another example of this exceptionally close relationship. Correlation doesn't equal causation, of course, but the "experiment" has been done over and over many times in many different populations and the results are always the same: failure to vaccinate allows previously eliminated diseases to come back.

Thanks, the post on herd immunity looks very good.

Does your wife's non-wish outweigh your wish? Why?

I'd rather convince her with facts rather than making an ultimatum. In the end, it's probably not life and death. It's true that many of these diseases are extremely rare, and often rarely cause death or permanent injury. But I'm also thinking about other children who for some reason can't get vaccinated or are still susceptible after vaccination.

The sad thing is, you'll rarely convince anyone with facts, as soon as we are just ever so slightly into emotional or quasi-religious territory. Which is why antivaxers, moonhoaxers, and other assorted charlatans have such an easy run at us rational folks' expense.

Your best bet is probably to try scaring the shit out of her. Sorry, I didn't invent this state of the world.

I think a major point your wife and others don't understand is that being vaccinated doesn't mean you can't get a disease. But most diseases will be less deadly and harmfull

So the statistics most anti-vaxxers look up are about disease count while you should look at how many died.

And about mercury: sometimes traces can be found but are way too low to be harmfull. There is a much higher dose of mercury in some fish so that's why pregnant mothers and small kids should not eat those.

Are you and your wife vaccinated? Great, you survived all sorts of possible illness from Measles to Polio (which doesn't exist anymore thanks to ... vaccinations!). Now give your kids the same chance.

My wife was sorta-sceptical or rather ignorant on the topic but it didn't take me long to persuade her otherwise. Great tip, go all three together to those vaccinations, reduces stress for everyone and take off the rest of the day because some kids will be all agitated. That needle is a small break of trust your kid has in you, make sure you make it up to the kid.

Autism, the shitty idea Andrew Wakefield brought up and lost his license afterwards due to "for unethical behaviour, misconduct and fraud". Read it up on Wikipedia https://en.wikipedia.org/wiki/Andrew_Wakefield Don't follow what a Playboy model says when the software-magnate-turned-philantrophist is calling for more vaccinations https://en.wikipedia.org/wiki/MMR_vaccine_controversy#Impact...

Sanitation, nice idea, but I think sewage system did the better job there (think Cholera). Air-born diseases don't care about how clean your hands are, and tbh, your immune system likes it dirty every now and then. If you know what I mean.

Btw, immune system, the longer your breast-feed the better it is for the kid's immune system and I hope your wife followed the WHO information on that. http://www.who.int/topics/breastfeeding/en/

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