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Measles Spike in US

The Centers for Disease Control (CDC) announced in a recent press release the data for 2013 so far shows 175 confirmed cases of measles in the US. This is about three times the usual rate of 60 per year since endemic measles was eradicated in the US, and is the most in the last decade other than 2011, which saw 222 cases.

Measles is a highly contagious virus that primarily causes a respiratory infection. It is not benign. According to the CDC:

About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis, and one or two out of 1,000 die.

About 500 Americans died each year of measles prior to the introduction of the vaccine. Measles is still endemic in Europe and many other parts of the world, causing about 20 million infections and 164,000 deaths each year.

The US has high overall vaccine rates and due to the measles vaccine, endemic measles was officially eradicated by 2000. A recent study finds that measles is still eradicated – officially this means there are less than one case per 1 million people. Being endemic means that the virus is being passed around within the population. High vaccine rates keep this from happening through so-called herd immunity – the virus has no place to go and the infection dies out.

Most new cases of measles in the US, 88%, are imported from outside the country by travelers. When such imported measles hits a community with low vaccination rates, however, and outbreak can occur. While overall vaccinations rates remain high there are pockets of low vaccination in communities with philosophical objections to vaccines.

In fact the largest recent outbreak of measles, 58 affected individuals, occurred in an orthodox Jewish community in New York. Such outbreaks are increasingly common. It is no mystery why this is – 65% of cases of measles occur in those who are unvaccinated (with 20% having unknown vaccination status).

You are more than 22 times more likely to get measles if you are not vaccinated than if you are vaccinated. Further, if you are vaccinated but still get measles you likely caught it from someone who was not vaccinated. Communities with high vaccine refusal rates are more likely to have outbreaks than communities with high vaccination rates.

The evidence is clear. The MMR vaccine works against measles. It is responsible for eradicating measles from the US, with only sporadic imported cases. However, since eradication in 2000 pockets of vaccine refusal have cause outbreaks to occur. So far measles is still not endemic in the US, but it might once again gain a foothold if vaccine refusal rates increase.

This is all a legacy of anti-vaccine fearmongering and misinformation.

Posted in: Vaccines

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44 thoughts on “Measles Spike in US

  1. Chris Hickie says:

    Of course, everyone’s least favorite “I’m not anti-vaccine even though I really am very anti-vaccine” pediatrician Dr. Bob Sears doesn’t think this is any big deal (http://www.askdrsears.com/news/sears-family-blog/measles-outbreaks-reason-panic), with his own facebook page post linking to this getting a worrisome 248 likes. Given that one of Sears’ own unvaccinated patients started the 2008 San Diego County measles outbreak (http://healthyliving.blog.ocregister.com/2008/12/29/ocs-dr-bob-sears-discusses-measle-outbreak-on-npr/1974). I do so wish someone in charge at the AAP would wake from their slumber of apathy to heap justly deserved criticism all over Dr. Bob’s parade of anti-vaccine fearmongering and misinformation.

    1. Lawrence says:

      @ChrisHickie – given that there should be ZERO measles cases because of the readily available and effective MMR vaccine (not to mention the fact that we’ve eradicated domestic measles), I see this as a huge increase & huge problem…..when people start dying, what will the anti-vax folks say?

      1. Young CC Prof says:

        When I tried to explain that H1N1 killed 350 children in the USA in 2009, I was told, “350 people is hardly an epidemic.”

        Most of the vaccine questioners changed their tune very quickly when people start dying. But to the true rejectionists, they’re acceptable losses in the pursuit of biological purity. Clearly they’re evolutionarily unfit and weren’t meant to live.

        1. AnObservingParty says:

          And yet ONE anecdote of temporally associated death out of MILLIONS of doses is immediately a tragedy. What are the numbers on when a tragedy officially becomes a faceless statistic?

          It’s all about control, or at least the illusion of control.

        2. goodnightirene says:

          “…they’re acceptable losses…”

          Just wait until it’s one of THEIR kids. Sadly, that is the only thing that will drive the point home for the hard core anti vax.

          1. Young CC Prof says:

            In the extreme natural childbirth circles, there are women who’ve lost babies by attempting to birth without medical assistance. Some of them still don’t admit that they did anything wrong, or that a hospital might have saved the baby. Heck, sometimes losing a child actually hardens their opinions. I mean, how do you process the fact that your child’s death was your own stupid fault?

      2. Sarah A says:

        They’ll say, “Were they eating an organic diet? Maybe their immune systems were weakened by toxins.” If the victim is an infant, they’ll add, “Did you breastfeed? Did Mom get vaccines during pregnancy? Were you using BPA-free bottles? Etc, etc, etc…” It’s enough to make you want to give up on humanity, watching parents who’ve lost a child to a VPD being grilled like rape victims in the “bad old days.”

        1. Calli Arcale says:

          Yeah, that’s the beauty of the “living right” model — it is immortal because any failure isn’t seen as a failure of the model but as a sign that somewhere they overlooked something that was done incorrectly. It seeks perfection, which is of course unattainable. (Side note: we are less than two weeks away from the celebration of the birth of a man who came into the world to point out the folly of trying to be perfect. He’s got probably a billion followers today, and yet we still struggle with that concept that perfection *isn’t actually achievable*. Despite the total lack of evidence of anyone actually being perfect.)

          The recent discussion about faith healing is very apropos to this discussion too. It’s astounding how people fully committed to that idea (that perfect living will yield a perfect state of health) will contort themselves to perceive their health as perfect even when it is transparently not.

          “The very powerful and the very stupid have one thing in common: they don’t alter their views to fit the facts, they alter the facts to fit the views, which can be very uncomfortable if you happen to be one of the facts which needs altering.” — the Doctor

          1. mousethatroared says:

            Love that quote!

    2. Sawyer says:

      Someone could spend 5 years writing a dissertation on the bizarre position Dr. Sears has put himself in and still not cover all the bases. His views are such an odd mix of somewhat sensible concerns, half-truths, and flat out lies. I’ve never understood his position because of the crazy level of cognitive dissonance it must require, compared to the regular antivax nuts that just have everything wrong across the board. Maybe it will forever remain a mystery.

      1. WilliamLawrenceUtridge says:

        Did anyone read the Times story on attachment parenting and his part in it? Particularly the article where it basically said “attachment parenting only exists because Dr. Sears’ mom didn’t hug him enough”? He created this huge effort of intensive parenting and spread it like a tumor throughout society, portraying it as if it were some sort of universal solution to all parenting woes, urging parents to attach their children to them like limpets, all because his mommy didn’t hug him enough.

        1. TwistBarbie says:

          “attach their children to them like limpets”

          Ahahahaha! That is too funny!

        2. Randyextry says:

          That may be the stupidest comment I’ve ever seen on the internets.

          1. WilliamLawrenceUtridge says:

            Why? Is it because you practice attachment parenting, and are trying to justify to yourself the massive self-abnegation and time-suck of the practices it urges? The huge investment in just breastfeeding alone, both in terms of time and in terms of willpower to keep doing it when your child can ask for it in full sentences? Are you trying to justify to yourself all that self-sacrifice when tickling away at your subconscious is the question, “will it make a difference, or could I maybe have taken some time for a shower?”

            Have you looked into the specifics? For instance, the way he bases his ideas on tribal and stone-age cultures, despite living in the first world? The way he treats the minor elevations in cortisol from a small amount of crying as if it were the same thing as massive spikes from horribly traumatic events or long-term neglect?

            Are you trying to rationalize your decision to delay vaccinating based on the Sears’ modified (and dangerous) schedule? Do you feel bad because of the way this puts your child at risk of infectious diseases for longer than you should? Or is there a slight twinge of guilt at the fact that your kid may give measles to someone with a compromised immune system, who may then die because of it?

            Or do you just like hurling insults?

        3. mousethatroared says:

          Limpets, hehe. In adoptive parent circles there is a phrase, “Velcro baby” This is a child, usually newly adopted, that clings to their parent (usually they chose one) and will cry and fuss if that parent leaves their sight or puts them down. In most cases, the clinginess resolves over the course of several months as the baby/child starts to feel more comfortable in their surroundings.

          Limpet baby, Velcro baby. I’m not sure which phrase is better. :)

          1. WilliamLawrenceUtridge says:

            The difference is, the goal for adoptive parents is to have the child develop enough confidence to separate. For attachment parenting, in my admittedly biased and charicaturist viewpoint, is to foster the exact opposite. I read a book on “natural” parenting, of which attachment parenting is one of the foundational beliefs, and one point the researcher discovered was the mothers ongoing negotiation of more and more children, particularly young children, to be brought into the family. My projection on this, is a complete lack of identity aside from “mother”, and the inability to tolerate not having a dependent child.

            But then again, I kinda hate the whole concept.

            Abstract discussions about parenting truly brings out the worst in people :(

            1. mousethatroared says:

              I don’t know WLU – I just wanted to share my velcro baby story. ;)

              My main complaint with attachment parenting is that it can sometimes lead unwitting parents to the organization ATTACH, which is a problematic group.

              I have no issue with the baby wearers. I do think it’s important that parent remember they have to care of themselves, physically and emotionally in order to parent to the best of their abilities. I sometimes worry that attachment parenting is sometimes too demanding and alarmist, but it’s not alone (amongst parenting methods) in that regard.

              1. WilliamLawrenceUtridge says:

                It just amuses/angers me that it puts so much emphasis on tasks that soak up the whole of the parents’ (and let’s face it, the mothers’) attention (and identity) with the promise that this will produce the perfect child.

                The utter confidence that attachment parenting proponents have when claiming this, plus the explicit or implicit claim that all other types of parenting will result in catastrophic outcomes (never mind the fact that attachment parenting is rather new, but healthy children and families have existed for a very, very long time) also irks me.

              2. mousethatroared says:

                @WLU – Yes! – your last paragraph. It’s what I was trying to say, but couldn’t find the words. The same goes for many of the other parenting books/methods today. But I don’t blame the parents who are into attachment parenting. I blame the attachment parenting “experts”.

              3. WilliamLawrenceUtridge says:

                Mouse, I really recommend to you Baby Meets World by Nicholas Day. It’s mostly history and anthropology, and goes into a lot of truly fascinating cross-cultural and historical examples of how babies were/are treated. For instance – in England in the 19th century, the proper way to feed your baby was with a mash of bread and milk, poured into their mouth with a special cup. They were considered “full” after they had vomited. Twice.

                But his best and overall point is this – beyond a certain threshold, beyond meeting some basic needs, all cultural practices are pretty much irrelevant in terms of biological thriving. You can swaddle your baby – or don’t. You can breastfeed – or don’t. As long as they get enough food, sleep and affection, it doesn’t matter. Anything above these basic needs being met is more about survival within a context than anything else. North Americans raising their children like the !Kung doesn’t make for happier, better-adjusted children, because we don’t live in the Kalahari desert.

                He has a supplementary series of posts on Slate that were also interesting, but perhaps better after you’ve read the book.

              4. mousethatroared says:

                WLU – Yes, that makes sense. I may have to check out that book. I don’t get tons of time to read outright, but there may be an audio version.

                But here’s the thing, children are still developing humans who you need to live with on a daily basis. Generally, everyone (in the home) has a better quality of life, in the present, if the parent can figure out ways to deal with car rides, tantrums, running into the street, sleep, shots, meal times and eating a reasonable diet, homework, school and extracurricular activities, screen time, dating, bullying, drugs, etc in as constructive a way possible. Some methods of dealing with these situations will either smooth things out or make things rougher over the next year, two, three even if it doesn’t permanently scar the child., That is me, ms. short term quality of life..

                Also, there are definitely things that parents may miss that can result in long term problems for children, problems that may stay with them as an adult. Clearly we see medical situations here on SBM. Mental health and drug abuse issues that aren’t addressed can be another problem, as can learning, speech, physical or cognitive disabilities that aren’t appropriately managed.

                These don’t have much to do with attachment parenting, but it may be helpful in understanding why the field of parenting gets so much attention.

              5. WilliamLawrenceUtridge says:

                I can understand why parenting trends can get so much love, hate and dogma attached to them. Parenting is a one-way street, you can’t go backwards. It’s free-form, there’s no built-in structure. You have to justify your decisions, and most people will do so through the resolution of cognitive dissonance discussed in Mistakes were made (but not by me). This generally includes refusing to admit an error and doubling-down on most rationalizations and decisions. It’s like marriage, with no prospect of divorce. You have to convince yourself it’s all worth it. Those trends and fads are like life rafts, something to cling to during the roiling maelstrom of childrearing.

        4. ebohlman says:

          Actually it’s “Dr. Bill” Sears, the family patriarch, who’s the AP guru; “Dr. Bob” is the best known of his kids (who are mostly pediatricians themselves).

      2. AnObservingParty says:

        That, and I think customer base. It almost looks like he wants to create a space that appeals to antivax, crunchy parents as a “safe space”…and also maybe the sane ones too. Inclusionary, compromised, giving both sets of parents what they want when they go…money.

        Yet that’s what we get accused of.

        And as a sane person, I should as hell wouldn’t go to him.

  2. rork says:

    I recommend the comments to the paper in the last link.
    The first one (http://jama.jamanetwork.com/article.aspx?articleid=1031245) was in need of review by math police – see if you can spot the problem with “Moreover, any risk imposed by exemptors on others is at least 2 orders of magnitude less than the risk they willingly assume themselves”
    The second one (http://jama.jamanetwork.com/article.aspx?articleid=193399) has a nice review of some historical papers.

  3. windriven says:

    We can vaccinate against measles, rubella, smallpox, polio, HPV and hepatitis. Sadly, a vaccine against stupidity has proven elusive. Makes me want to rethink the ethics of eugenics.

    @Lawrence

    “when people start dying, what will the anti-vax folks say?”

    (Ivan Drago voice: ) “If they die, they die because they did not adhere to the recommended regimen of acai smoothies and coffee enemas. Nothing to do with vaccination”

  4. Lawrence says:

    Overall, this is just the tip of the iceberg. A lack of vaccination (or a drop below herd immunity thresholds) can take a decade or more to make itself known – just look at what is going on in the UK right now….they didn’t immediately see a spike in Measles cases, instead it took about a decade for the first large outbreaks in vulnerable populations to appear.

    Given that timeline, we should start to see larger outbreaks (1000+ cases) in about 5 years or so – depending on the rate of importation of measles from overseas….it is also quite possible that Measles could become endemic again, though overall vaccination rates here in the US remain high (though we have numerous very under-vaccinated pockets).

    1. Sawyer says:

      it is also quite possible that Measles could become endemic again, though overall vaccination rates here in the US remain high (though we have numerous very under-vaccinated pockets).

      There are times when I’ve considered registering for one of those psychic prediction challenges, because I can see EXACTLY how this would play out. People will start making a greater effort to vaccinate after the first really big spike. Anti-vaxxers will still refuse. Vaccine rates will go up, but for several years incidence of disease will still continue as well. This 2 or 3 year correlation will become the crown jewel of the anti vaccine movement, despite the fact it doesn’t reflect what’s really going on. Vaccine rates will drop again, and drug companies will just give up making them. I don’t want to spoil the ending for anyone, but it’s not pretty.

      I should disclose that Sylvia Browne’s ghost revealed this future to me in a dream. I will cannot reveal any other psychics revelations about vaccines unless given financial compensation.

  5. mho says:

    If you have a moment, leave a comment in this article in the Denver Post. Colorado is actually calling for stiffening the personal exemption requirements, and of course, the anti-vaxers have jumped in. (Colorado has the worst vaccination rate in the country)
    http://www.denverpost.com/news/ci_24698639/coalition-recommends-making-it-harder-opt-out-child

    1. windriven says:

      For those who will comment on the Denver Post piece, don’t put it off. You have to register (free) but activation isn’t immediate. The site administrator has to review the application. No idea how long that will take. Logins from services like Google and the loathsome Facebook do not appear to be supported.

  6. Carolyn says:

    This may be a stupid question, but how old is too old? I’m old enough to have gotten a smallpox inoculation, and am up to date on my Old Fart vaccines (shingles, pneumonia, etc.) Since I worked in a clinical lab, I’ve had the hepatitis series, too. I updated my Tdap since I’m around the grandkids.

    The MMR came out when I was in college, mumble-mumble years ago, and I’m pretty sure I didn’t get it. Is this something Seniors should consider getting, or assume we probably had measles back in the bad old days?

    1. nancy brownlee says:

      @Carolyn
      I’m 66, and I’m pretty sure I had everything a first-wave boomer could get- measles, mumps, rubella, chicken pox, even whooping cough- in spite of having the available vaccinations. I recently got ‘boosters’ for all – we’ve had a measles outbreak here, centered around a huge fundamentalist Xtian church in the area. I figured, my immunity has certainly weakened by now- and I do remember what a mild case of pertussis feels like. It’s horrible. Just do it- it couldn’t hurt!

    2. Harriet Hall says:

      See http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule.pdf for full recommendations for adults of various ages. Read the footnote 7. Those born before 1957 are generally presumed immune to measles and mumps, but health care providers should still get the vaccine.

      1. Alia says:

        Thanks for that, Dr Hall. I’m 30+, had all the recommended shots when I was a kid, never had any childhood VPD except for chicken pox. I work with teenagers in a large school. And when I went this year to have my flu shot, I asked the doctor whether I should consider any other vaccines, she talked only about Hep B, which during my childhood was not obligatory and which I already had (3 shots plus booster, because my antibody count was very low). And yet I see from the chart that I really should consider a Td booster. Well, it seems I should find another doctor.

  7. AngelaTC says:

    I have a stupid question too. Are vaccine rates actually falling in America?

    1. windriven says:

      Too broad a question, AngelaTC. Which vaccine?

      In general vaccination rates have been rising according to CDC – at least as of 2011. But rates vary by vaccine and by state.

      According to CDC (2012 numbers now) Rotavirus vax varies from a low of 54.2% in Washington, DC to a high of 83% in New Hampshire. Don’t know what those have been historically but troll CDC and you can find out. I was shocked to learn that polio vaccination is only 83% in Kansas. These numbers are all for children at 24 months. I was also depressed to learn that MMR vax in my own state of WA is only 82% at 24 months. Compare with Rhode Island at 97%.

  8. Kiiri says:

    Those of us in PH have been watching the measles vaccination rates with trepidation. While overall high the pockets where immunity is dangerously low means that every importation could lead us right back to endemic transmission. No one wants to deal with that. Particularly since PH funding has suffered such dramatic cuts in the last 5 years. Unless we can encourage vaccinations (and I am heartily in favor of making an exemption extremely difficult to get) it really is a matter of when not if we go back to endemic status.
    On attachment parenting as a fairly new mom (the little man is only 2 and no we’re trying for a sibling so back to fertility we go) the entire idea is complete rubbish. I didn’t carry or wear my child, breastfed for only 3 weeks (not exclusive as I quite frankly just never made hardly any milk), went back to work full time at 8 weeks of age, started putting him down in his own crib in his own room at 4 months, and always put him down awake. He is lovely, sweet natured, securely attached, and well behaved. He is also 100% completely vaccinated.

  9. Kiiri says:

    To answer AngelaTC’s question, overall if you look at the numbers we have a high percentage vaccinated. If you start breaking that down by state, and even more worrisome by community you begin to see the dangerous holes forming. Also, the number of philosophical exemptions has risen dramatically every year. If you talk to your local PH authority they can tell you off the top of their head which community has low coverage. I can certainly tell you which ones here don’t have adequate coverage.

  10. norrisL says:

    As I commented on the recent vaccine post, vaccinate your children and keep them off the freeway

    1. mousethatroared says:

      + Put them in car safety restraints, lock up your medications, watch them closely in the water and teach them to swim, watch out for strangulation hazards and lock any guns in the house. Always check for children before backing up the car and in my region, check the ice before allowing skating, etc.

      (Sorry, I’m a detail oriented worrier.)

  11. Feniks says:

    The measles are still endemic here in Europe, despite free vaccination programmes, and there are occasional outbreaks involving hundreds of cases, hospitalisations and occasional deaths.

    Earlier this year, a young man died of measles in Wales, Great Britain, and a teenage girl died in The Netherlands. They were both not vaccinated. So what is the reaction of the anti-vaccine lobby in these countries? These are some of the reactions I have seen:
    - The young man was seen by a GP a few hours before his death, but not treated properly. So it is not the measles’ fault , it is the doctor’s.
    - The young man had other (chronic) medical problems, so his immune system could not fight the disease.
    - The teenage girl sat in a wheelchair and always had problems breathing, so her immune system could not fight the disease.
    - And how many people have died BECAUSE of the vaccine (this is always a question or a hollow statement, the anti-vaxers cannot give a proper answer, and don’t accept the true answer)

    Basically, these two entirely preventable deaths are seen as “not relevant”, because of other medical conditions. But isn’t it just for the more susceptible people that vaccines are even more relevant?

    1. Calli Arcale says:

      Sometimes there’s a nasty eugenics undercurrent — if you’re sick already, then it’s okay if you get measles. But I think very few of the people making those arguments actually think of it that way. They’re approaching it from the other side: if my child doesn’t have asthma or a compromised immune system, then these stories don’t give me a reason to get my child vaccinated. My child is healthy; my child won’t die if she gets measles.

      So it’s not quite as vicious a line of reasoning, but it is a very self-centered one. Obviously, someone thinking along these lines will also not be swayed by public health concerns; since they’re only thinking in such limited terms, they will be baffled by the public health arguments. I mean, my child is healthy; obviously it’s possible to have a healthy child without all this vaccination stuff, so why can’t you just do what I do? If you can’t, well, that’s not my problem. Very short-sighted.

      Also naive, of course, since a) measles can kill someone without known health problems, and b) just because you think your child is healthy doesn’t mean he or she actually is.

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