I readily agree that there's potential for confusion on the interpretation of the definitions, and it seems some numbers simply don't add up when multiple sources are considered. I'm keenly interested to see what I can do to get clarification on the data, and preferably access to raw data (presumably anonymized/scrubbed). Likewise, I don't have a firm explanation for the drop in vaccinations rates in 2013. The WHO 2013 data is listed as provisional of course, but given the tendency toward the fastest reporting coming from the most heavily populated/metropolitan areas in any given nation, I'm not anticipating a serious shift in the percentiles by the next update period.

I've lived in multiple U.S. cities with large Hispanic populations and also recall a positive attitude toward immunization in those communities. As you noted, upper-middle to upper class white families are indeed disproportionately likely to avoid vaccines in some areas. I happen to strongly disagree with their views, especially given the fact that I have a family of my own whose health matters immensely to me. The harm caused to communities caused by avoiding vaccinations is undeniable.

With specific regard to the drop in Mexican stats, I can't help but wonder if anti-vaccine fear-mongering has gained a stronger foothold in the country, although I certainly can't speak directly to that. There may be other factors as well; perhaps policies of the Enrique Peña Nieto administration (assumed office in 2012) are pertinent, or maybe large-scale destabilization associated with cartel activity has made a difference. This is simple speculation; I honestly have no idea why it's happening. I do note that in 2012, approximately 6.05 million Mexican unauthorized immigrants were residing in the United States, and the previously seen recession trend of declining Mexican illegal immigration appears to have reversed after 2010.

Is this you? If so, I'm concerned by the prospect of certain liberties having been taken with facts in your practice.

This plainly just isn't going to work out. I may print this entire thread out and mount it on a wall somewhere at the office, though. For now, I'm just going to go open a cider try to think happy thoughts. Cheers.

By the way, as a direct refutation of what you're attempting to portray with your last reply, please reference my recent reply to dmr001. Based on his comment history, I was already aware that he has claimed to be a physician in general practice, but felt it best to request he restate that in the context of that particular comment thread. You'll note that I did not simply accept his claims, and I offered contrary evidence following a suggested reason for the misrepresentation detailed in his comment. Perhaps he'll reply with something that will inform and surprise me.

I didn't accept anything. Please show me where I accepted anything at all rather than simply reject your own lack of rigor in posting your snarky, faux-superior dismissal of data, with my rejection being supported along the way via illustration of the continued ignorance of several of your statements. You're more than welcome to provide additional feedback on any of those points, provided you can back your positions with supporting data. Your fundamentally dismissive behavior is what I have been criticizing this entire time, and I just handed you a practical demonstration of the sort of initial response you could have made instead. Are you daft? For heaven's sake man, Bob Sears is a complete idiot at best, but you might just have him beat.

I believe you are misreading "Routine EPI vaccines financed by government (%) 2012" as indicating the population percentile that receives these vaccines. Instead, the statistics you've referenced are for the percentile of vaccination costs the Mexican government covered for the pool of individuals who actually received the vaccinations. This is also known as "how to push a particular social agenda using statistics while avoiding evaluation of its efficacy."

In 2013, the DTP1 (first dose) vaccination rate in Mexico was 90%, and the DTP3 (third dose) rate was 86%. In the same year, the DTP1 vaccination rate in the United States was 98%, and the DTP3 rate was 94%. It is also worth noting that to be maximally effective, three primary DTP (aka DPT) doses must be administered, per CDC guidance on DTP vaccination. Could you please clarify your specific role as a medical professional?

I'm greatly intrigued to learn of the existence of a myra bird who has been granted his MD or DO; please provide clarification if the degree conferred was another sort of doctorate (such as humanities). Further, I assume Dr. Bob made the assertion "it's bunk" in reference to a claim of an observed relationship between illegal immigrant communities and rates of transmissible disease infection. Please correct me if Dr. Bob's assertion was instead in relation to another field of study. Especially given the fact that the good avian doctor's finding appears to contradict data cited in this discussion that was sourced from publications which are generally regarded as reliable (or at a minimum not normally considered deceitful), could you please offer additional information on his observations, perhaps from a "bird's eye view" perspective? I understand that my data may be incomplete, or there may exist a need to allow for alternate interpretation of the present model. We eagerly anticipate this added insight, as we certainly won't be suggesting that Dr. Bob was merely parroting uninformed opinion. That would be for the birds; you'd have to be pretty high to believe such a flight of fancy would be possible for such an accomplished feathered friend. In any event, I'm glad you opened up this avenue for discussion on this very important topic.

You're lying. To be maximally effective, three primary DTP (aka DPT) doses must be administered, per CDC guidance on DTP vaccination. In 2013, the DTP1 (first dose) vaccination rate in Mexico was 90%, and the DTP3 (third dose) rate was 86%. In the same year, the DTP1 vaccination rate in the United States was 98%, and the DTP3 rate was 94%. Also, one presumes that for a variety of reasons, previously non-vaccinated illegal immigrants aren't going to rush to get their DTP shots once they're in the United States. Otherwise, we probably wouldn't see statistics like these.

Why are you lying?

You're lying. To be maximally effective, three primary DTP (aka DPT) doses must be administered, per CDC guidance on DTP vaccination. In 2013, the DTP1 (first dose) vaccination rate in Mexico was 90%, and the DTP3 (third dose) rate was 86%. In the same year, the DTP1 vaccination rate in the United States was 98%, and the DTP3 rate was 94%. Also, one presumes that for a variety of reasons, previously non-vaccinated illegal immigrants aren't going to rush to get their DTP shots once they're in the United States. Otherwise, we probably wouldn't see statistics like these.

Why are you lying? If your intent is not to deceive, and instead you are merely grossly misinformed, perhaps you should visit the link in your sig again for a bit of personal reflection.

You've just made your initial error all over again with your "from someone who might or might not have a clue what's going on" comment. The entire point here is that you shouldn't take a single experiential statement as full explanation of a phenomenon, but you also shouldn't dismiss things out of hand without good reason. Your lack of good reason is what has been demonstrated throughout this discussion, which has now gone recursive.

You're continuing to insist on exactly the sort of behavior that frustrates productive discussion on topics like this, encouraging people to ignore data points they may not like and consequently forgo further research and discussion on said data, based on a premise of ignorance masquerading as knowledge. It's sad, really.

With that, you were attempting to dismiss the GP's assertion that "the US have one of the highest rates of antibiotics (ab)use." He's actually correct, and you've missed the mark with your reply. Please reference my other reply on this subject.

Hospitals are anything but sterile environments, but the reasons for cross infection can be complex. Please review the following resources:

• Hospital-acquired infection - United States
• HAI Prevalence Survey
• Hospital-Acquired Infections - Frequency

Where are you getting your information?

Please substitute "productive" for "production" in my last reply. It's late here.

Far from it, and I've clarified that multiple times. This entire discussion between us has been in response to your statement "or he might have been repeating uninformed speculation. Most practicing physicians are not epidemiologists", which was an ill-considered suggestion for reasons discussed in this thread. To put it simply, that and subsequent statements on your part lacked substantial relevance in context and were collectively a transparent attempt to dismiss something you didn't like via a vague and unsupported attack on credibility. You ran with assumptions you were comfortable with, and the outcome was that your supposition of credibility in light of probable actual circumstances was demonstrated to be founded in ignorance.

Instead of taking an opportunity to contribute something of value to the conversation, you went the route detailed above. You could have used an inquisitive line to ask for more information on the scenario depicted, perhaps with some hypothetical lines of reasoning you might draw based on possible answers. If people are going to have production conversations on important matters, these things matter. You were called on it, and you've spent a lot of time trying to backtrack on it. Just put down the shovel.

Since you've referenced tuberculosis, perhaps you'd be interested in reviewing some relevant data from the CDC: Trends in Tuberculosis – United States

Here are some excerpts:

"How many cases of tuberculosis (TB) were reported in the United States in 2012? A total of 9,945 TB cases (a rate of 3.2 cases per 100,000 persons) were reported in the United States in 2012. Both the number of TB cases reported and the case rate decreased; this represents a 5.4% and 6.1% decline, respectively, compared to 2011*. The number of reported TB cases in 2012 was the lowest recorded since national reporting began in 1953. *Ratio calculation is based on unrounded data values."

"Is the rate of TB declining in the United States Yes. Since the 1992 TB resurgence peak in the United States, the number of TB cases reported annually has decreased."

"How do the TB rates compare between U.S.-born persons and foreign-born persons living in the United States? In 2012, a total of 63% of reported TB cases in the United States occurred among foreign-born persons. The case rate among foreign-born persons (15.9 cases per 100,000) in 2012 was approximately 11 times higher than among U.S.-born persons (1.4 cases per 100,000)."

You may also find the following information useful:

• Reported TB Cases, United States, 1982-2012
• TB Case Rates, United States, 2012
• Tuberculosis in Hispanics/Latinos

Given this data, please explain your simple solution for finishing up the job of TB eradication in the United States.

You certainly seem to be assuming a lot, but you don't appear to have much knowledge of the relevant topics. To avoid needless repetition and thread scope creep, please review the following related posts:

• Exhibit A
• Exhibit B
• Exhibit C

You have contributed nothing of substance to this conversation. In other words, your opinion is shit. Cheers.