Measles Outbreak: The Case for Vaccination

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Held by his mother, this infant receives immunization in his left thigh muscle. Photo courtesy of the CDC.

Held by his mother, this infant receives immunization in his left thigh muscle. Photo courtesy of the CDC.

This would be a great horror film, but instead is an amazing case study: What happens when people stop vaccinating against childhood diseases? The diseases come back, with a vengeance. Who would have expected that a trip to the Happiest Place on Earth over the Christmas Holidays could have led to a measles outbreak affecting at least 14 states and counting?

Between 2001 and 2010, the United States saw about 60 measles cases per year, according to Dr. Anne Schuchat, assistant surgeon general and director of the Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. 

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In the first 28 days of 2015, 84 measles cases have been reported in 14 states. All ages are affected: from seven-month-old infants to 70 years old, with the median age being people in their 20s. In 2000, health officials had declared measles was eliminated from the U.S. 

In 2014, there were 644 confirmed measles cases in the U.S. 

Why is it that a disease that is so preventable has struck back with a vengeance?

Lack of Community Immunity

Once infected, a person can spread the virus four days before they show symptoms. You can be walking around Disneyland, spreading the disease to every non-immune person with whom you come into contact and 90% of them will become sick.  The only reason the current numbers don’t reach the rates of the 1950s is because most people are vaccinated. We rely on the immunity of the community to prevent the virus from spreading.

But what of those who are not?  People who chose not to vaccinate accounted for 79% of the cases in 2014. In the current outbreak, most of those who became ill were unvaccinated or did not know if they had been vaccinated.  Some of those were infants less than 12 months old, too young to be vaccinated. And therein lies the problem: Choosing not to vaccinate not only puts your own child at risk, it puts at risk all those who can not be vaccinated for medical reasons.

This late 1960s photograph shows a Nigerian mother and her child who was recovering from measles; note that the skin is sloughing on the child as he heals from his measles infection. Photo courtesy of the CDC.

This late 1960s photograph shows a Nigerian mother and her child who was recovering from measles; note that the skin is sloughing on the child as he heals from his measles infection. Photo courtesy of the CDC.

The anti-vaccinator usually says, “Why are you worried if you’re vaccinated?” Because no vaccine is perfect. Vaccine efficacy for measles is close to 95%, depending upon when the doses are given.  

That means that 5% who are vaccinated will become ill, more if they only received one dose. And then there are the immunocompromised: Brandi Schemerhorn has two children with juvenile idiopathic arthritis.  The medications that they take are immunosuppressants, which means they cannot have live vaccines, which includes MMR.  They are entirely dependent upon the immunity of the community to keep their children safe.

Dr. Jack Wolfson, an Arizona cardiologist who practices holistic medicine, describes these diseases as a right of passage. But what about those who don’t pass through it, those that die or suffer debilitating consequences? In the U.S., one in every 1,000 cases will suffer encephalitis. One or two in every 1,000 will die. Since the vaccine was introduced in the 1960s, we have not seen that number of cases in the U.S. Will this be the year?

The potential link between autism and the MMR vaccine was studied extensively and debunked.  Now parents are worried about “putting toxins in our children’s bodies,” and have a distrust of the pharmaceutical establishment

Big Pharma” makes far more from your child being diagnosed with ADHD than it does off of two doses of MMR in a lifetime. 

One anti-vaccinator said she would not vaccinate because if her child gets a disease naturally, that’s just “one of those things,” but an adverse vaccine reaction is due to a parental choice. She said she couldn’t live with it if her choice to vaccinate led to severe illness or death.  When told her choice to not vaccinate is more likely to result in severe illness or death, she replied, “but that won’t be my fault because I’m not choosing for my kid to get the disease.”

If you’re playing the risk-benefit game, the risk of getting the disease, and suffering consequences from it, is much higher than the risk of adverse reactions. 

It’s tempting to write off non-vaccinators as ignorant, but many non-vaccinators are extremely smart, capable people (the person noted above has a PhD in a scientific field).  Knowledge in one area doesn’t make us an expert in all: I know a lot about infectious disease, but NASA isn’t going to ask me to develop a rocket.  Similarly, my rocket scientist husband will ask me to explain vaccines to him.  We are both “stupid smart people.” 

Personal Belief Exemptions, by state. Texas law has some of the most lax exemption requirements (Chapter §97.62).  A parent need only sign a statement and file it.

Personal Belief Exemptions, by state. Texas law has some of the most lax exemption requirements (Chapter §97.62). A parent need only sign a statement and file it.

Public health is partially to blame. For years we wrote off Andrew Wakefield and his ilk as quacks to whom no one would listen. Then the opposite happened, and the anti-vaccination movement gained steam. Not only has the theory been disproven, Wakefield’s paper was retracted by its publisher and Wakefield lost his license over falsification of data. Yet his credibility with uninformed continues.

Vaccination rates have climbed again in recent years but have yet to recover to pre-autism scare levels.

Vaccination rates have climbed again in recent years but have yet to recover to pre-autism scare levels.

See this New York Times story published today: A Discredited Vaccine Study’s Continuing Impact on Public Health.

Not all non-vaccinators made an active decision not to vaccinate. One parent describes a combination of factors: busy single mom, no health insurance, little time to wait in long lines in public clinics. Eventually the child received one dose of MMR, but was behind in other vaccines. Once she had insurance, most pediatricians refused to take her on as a patient because she was not up to date on vaccines. Finding one who would, insurance hassles again prevented it. This parent wants to vaccinate her child, but the system hasn’t made it easy.  The cost of childhood vaccines are covered by the Vaccines for Children program, but access to a provider can be problematic.

Here’s the good news: in Bexar County, 93% of children have been vaccinated for MMR

That sounds pretty good, except in some communities, the rates are much lower.

Then there’s the bad news: vaccine rates for all required childhood vaccinations are only at 71%.

And more bad news: the rate of “Personal Belief Exemptions” in public schools in Texas has increased dramatically (see graph).

personal belief exemptions vaccines

One hope is that we’ll see the Disneyland Effect, that given the outbreak, anti-vaccinators will rush out to vaccinate.  Unfortunately, research suggests that even photos of dying kids is not enough to sway people.

So how do we get people to trust public health? We can’t simply blame anti-vaccinators – they’re parents worried for their kids.  We must continue to educate, to explain the science, to improve access to health care to make it easier to get vaccines, to continue to research vaccines, studying potential adverse reactions, and improving them. 

*Featured/top image: Held by his mother, this infant received an immunization in his left thigh muscle. Photo courtesy of the CDC.

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12 thoughts on “Measles Outbreak: The Case for Vaccination

  1. The graph here shows an important phenomenon. Graphically, it looks like MMR vaccination decreased only slightly in the wake of the falsified Wakefield study. However, measles cases in that timeframe skyrocketed. This shows the importance of herd immunity for measles. Even tiny changes in the immune status of a community can have a significant impact on the level of disease.

    I don’t blame individuals, or even celebrities for believing erroneous claims. After all, they were made by scientists. I blame the scientists and medical professionals who falsified data and who continue to make false and dangerous claims about vaccines based on false data.

    (this graph is taken from this article http://www.nhs.uk/news/2010/01january/pages/mmr-vaccine-autism-scare-doctor.aspx)

  2. It’s demeaning to those on the spectrum (asd) to be told that a parent would rather their child suffer from and possible die from a preventable illness than be diagnosed with autism.

  3. Thank you for this. This needs to be shouted from the rooftops, it needs to be law. We can’t continue a few people who value opinion over fact, and who dangerously ignore history, to kill more innocent people. The letter from Charlie and the Chocolate Factory author Roald Dahl that has been circulating the internet today says it all.

    “Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

    ‘Are you feeling all right?’ I asked her.

    ‘I feel all sleepy,’ she said. In an hour, she was unconscious. In twelve hours she was dead.”

    http://roalddahl.com/roald-dahl/timeline/1960s/november-1962

  4. It’s also important to note that anti-vaxxers aren’t the only problem. Access to health care is indeed a real issue, and one San Antonians are facing. Difficulty in accessing health care means difficulty getting vaccinated.

    Most children in this population catch up by the time they reach school age, but there’s a definite gap until then. For this reason, San Antonio Metro Health invited The Immunization Partnership to set up a chapter in San Antonio. TIP is a non-profit which has worked in Houston since 2007, and has been effective there in bringing their rates up. TIP will work in collaboration with SAMHD and other entities in San Antonio to improve vaccine rates for the entire county. 71% coverage is just too low. It’s even lower for adolescent vaccines.

  5. I got the vaccine and as a young adult I got the measles three times. Not too mention in the last 10 years the vaccine has changed 4 times, the CDC official will neither confirm nor deny anything about the vaccine and its side effects, in the last ten years zero people in the US have died from the actual virus but 108 have died in that same time frame in the US from the vaccination. Im sure all those have been debunked too huh? Oh except that they come from government websites…….

  6. 102 confirmed cases/ ~315 million people… hmmm people act like we still live in the early 1900s and work in very unclean envisioned and/or are very unhygenic… Vaccines weren’t the only thing that did away with those almost archaic diseases. Its weird to think that our immune systems would be so compromised that we require medication of all kinds for “preventative” measures… or maybe we’ve become so dependent on it that that is what required to stay healthy.. All I really have to say is that since the people who create these vaccines also engage in creating weaponized virus strains.. and that most epidemics/ infected areas begin with some fuck up within their organizations and/or the CDC itself. Why is that?

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