Return of an old foe

In 2000, a panel of experts was brought together by the Centers for Disease Control and Prevention (CDC). They came to discuss whether measles was still endemic in the United States, that is whether it still existed in the general background of US infectious diseases. They concluded that measles had been eradicated in the US, and that the occasional cases imported from abroad were stopped by a wall of vaccinated Americans.

Welcome to the future. The US is in the middle of its largest measles outbreak since 1996. Most of the cases originated abroad, brought back by unvaccinated travelers, either American residents or foreign visitors. This has so far led to 12 outbreaks (that is, a cluster of three or more connected cases) mostly among the unvaccinated. Of the 139 cases who were US residents rather than foreign visitors, twelve had documentation of adequate immunization.

The surprise isn’t that a few cases should slip through the wall of vaccination, but that the wall has so many chinks in it. The number of measles cases being imported, and the falling vaccination rates of Americans may reach the point soon where we no longer need to import our measles as it will once again become endemic.

Measles isn’t just a curious disease that we learned about in medical school (“cough, coryza, conjunctivits”); it’s a serious disease that leads to pneumonia in 1 in 20 children, and brain inflammation in 1 in 1000. Outside the US, it causes hundreds of thousands of deaths yearly.

We must increase our efforts to vaccinate all US residents properly (including undocumented residents). If measles does take hold once again in the U.S., the blame will fall squarely on our health care system’s failure to deliver vaccine, and on those who for whatever reason delay or avoid vaccination altogether.

It used to be that Americans viewed public health battles with excitement, a battle against fear itself, against the fear of children choking to death from whooping cough, or becoming paralyzed by polio. Now, as we sit behind our crumbling shield of vaccination, we have become complacent. If we fail to act, our complacency will be replaced by very real fears, especially for our children.

Posted in: Vaccines

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4 thoughts on “Return of an old foe

  1. DBonez5150 says:

    “Those who cannot remember the past are condemned to repeat it.” George Santayana

    Seems we may have generations of people who are condemned to repeat a horrible history of disease and death because they live in a time of health, comfort, and prosperity never known in history. Followers of science-based medicine, both the blog and in practice, are aware of the history of the diseases that vaccines prevent and gladly follow the CDC’s recommendations lest they experience the horrors of the past.

    On the other hand, followers of woo, and more specifically the anti-vaxers, know little or nothing about vaccine preventable diseases’ awful history. They live in near perfect health and see vaccines as nothing but an inconvenience with no benefits and some risk and opt not to immunize their children. This post nicely illustrates the past coming back to give us an ugly, deadly history lesson. Too bad it’s the innocent who will likely get the brunt of the lesson and the anti-vaxers will continue to skate through life, ignorant as ever.

  2. lilady says:

    The MMWR October 28, 2011 issue reports 202 cases of confirmed measles, YTD (week ending October 22, 2011). These 202 cases do not include the six confirmed measles cases that were reported by the NYC Department of Health. According to a press release the six cases are all members of an Orthodox Jewish sect in Brooklyn and “some” of the children were never immunized. To put this in prospective, total confirmed cases of measles for each individual year 2006-2010 are:

    2006-55 cases, 2007-43 cases, 2008-140 cases, 2009-71 cases, 2010-63 cases

    It appears that when all the confirmed cases of measles are tabulated for 2011, we will have a major problem with the “Return of the Old Foe”.

    It is a problem with the anti-vaccine movement and their changing goal posts. At first it was thimerisol, then the discredited Wakefield “gut” research, then “too many vaccines too soon”, then the movement to manufacture “green” vaccines by removing adjuvants and excipients and….have I missed any of the other “theories”?

    How about more recent State legislation to allow PBEs (personal belief exemptions) and its impact on admitting kids to school who are unimmunized? Of course the proliferation of anti-vax websites which provides “wording” to claim those exemptions, along with every crackpot theory that links vaccines to autism, are a huge part of problem.

    Now we have a newer “movement” for health care freedom, free choice and keeping government regulations out of health care choices. So much for progress…sad.

  3. cervantes says:

    Since measles has no non-human reservoir, and is vaccine-preventable, it’s one of those diseases which is potentially eradicable. As a matter of fact, it’s easier than polio because you don’t have the problem of accidentally creating outbreaks from live-virus vaccine. However, it seems there is no political interest in trying these days. Might have to spend some taxpayer money, you know.

  4. A friend sent me this link from Slate today. Nice to see a mainstream source taking a pro-vaccination stance.

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