Is history repeating itself?

This is the fifteenth of 16 student posts, guest-authored by Cassie Klostermann. 

One of the major accomplishments that public health professionals pride themselves in is the reduction of people getting sick or dying from preventable infectious diseases. Unfortunately, these debilitating, historic diseases that health professionals had once thought they had under control are starting to rear their ugly heads once again in the United States (U.S.). One of these diseases that I am referring to is measles. Measles is a highly contagious virus (from the genus Morbillivirus) spread through the air when an infected person coughs or sneezes making measles extremely easy to get by being around someone who is sick with this disease. According to the Centers for Disease Control and Prevention (CDC), if someone has the measles virus they could potentially infect 9 out of 10 people they come in contact with who are not immune (i.e. not vaccinated) to the disease.

Some of the most common symptoms associated with measles are fever, runny nose, and cough which are also very similar to the symptoms of many other diseases. Measles also commonly causes a rash that can cover the entire body. Those who have measles can spread the virus to another person about 4 days before and after the rash shows up. There are also a few more rare but more serious complications that can develop from having the measles virus such as pneumonia and encephalitis and it can also lead to the death of those infected.

The word measles comes from the Middle Dutch word masel meaning “blemish.” The history of measles cases goes relatively far back into history with references of the virus appearing in records as early as 700 AD. In the U.S., before the vaccine was introduced in 1963, there were about 3-4 million cases (essentially every child had had the disease by the time they were 15 years old), about 1,000 people suffered deafness or permanent brain damage (from encephalitis, for example) and around 450 people died from measles each year. By 2000, naturally occurring cases of measles in the U.S. (meaning cases that originated in the U.S. rather than another country) had been eliminated, although there are normally about 50 measles cases per year in the U.S. that come from other countries where measles is endemic (or constantly present in their population) and with increased worldwide travel people need to be more aware of their risk for contracting measles. Throughout the world, there are an estimated 20 million cases leading to about 164,000 deaths from measles each year, which is a great improvement from the 2.6 million deaths that occurred before the measles vaccine was globally used. The number of measles cases, long-term diseases, and deaths caused by measles are going down year by year and much of this progress can be attributed to efforts that provide the measles vaccine worldwide.

While the overall number of measles cases throughout the world are decreasing (mostly from decreasing cases in developing countries) the U.S. and other developed countries are seeing the opposite trend. According to the Notifiable Diseases and Mortality Tables from the Morbidity and Mortality Weekly Report, there were 223 reported cases of measles for 2011 occurring over 17 outbreaks in the U.S. (the average number of outbreaks is 4). This is an increase from previous numbers (63 cases in 2010 and 71 cases in 2009, to name a couple) and the majority of people infected, about 65%, had not been vaccinated against measles even though most of them were eligible to get the vaccine. Out of the measles cases seen in 2011, 90% were traced back to measles viruses seen in endemic countries and brought back to the U.S. where it was spread person to person in the States. Even though historically measles cases have been high in developing countries (especially Africa and Asia) extensive immunization programs have greatly decreased the amount of cases per year. Now European countries are seeing a large increase in their numbers of measles cases since 2009 because the number of vaccinated people has decreased.

The only proven way to effectively protect someone against contracting measles is to get the MMR (measles, mumps, and rubella) vaccine. If you have not been vaccinated then you are leaving yourself vulnerable to getting the diseases included in the MMR vaccine. This issue doesn’t just stop with the individual person, it spreads to everyone that individual comes into contact with. As mentioned above, measles is highly contagious and is spread through the air when an infected person coughs or sneezes so it can easily infect anyone breathing the same air you breath that is also vulnerable to the disease. When people who are vulnerable to getting the disease breathe in the contaminated air, they have a fairly high chance of getting measles and it is important to keep in mind that there are people who cannot get the MMR vaccine because they are either too young (under 12 months old), too sick (i.e. cancer patients), or the elderly who may have lost some of their immunity. For these people, they do not have a choice as to whether or not they get the vaccine, but they still deserve to have some protection from diseases prevented by vaccines. This protection comes from a concept referred to as herd immunity where there are enough people in a community or country vaccinated against a disease so that is unable to be “kept alive” because there not enough vulnerable people for it to pass through. If we are able to keep herd immunity up high enough by having enough people vaccinated against the measles, then the number of measles cases per year could drop back down to the normal 50 per year instead of 220 per year.

Travelers especially need to keep in mind that although a disease, like measles, is usually a rare occurrence in the U.S., this is not the case in many other countries in Europe, Asia, and Africa as examples. People traveling to countries where measles is endemic really should consider being vaccinated because their risk of being infected is much greater due to the higher number of people in the country infected with the disease.

As with anything in medicine, vaccines can cause reactions in rare situations and I urge people to ask their healthcare provider any questions they have regarding the MMR vaccine. I also urge people to receive all of the recommended vaccines they can (unless they have had past allergic reactions to a specific vaccine) because the risk of contracting measles and dying from it is more common than having a more moderate reaction to the MMR vaccine. If you or your kids are eligible to receive the MMR vaccine, please, please get vaccinated and talk to your doctor if you have concerns about an allergic reaction. By getting vaccinated you are not only protecting yourself and your children but also those who are unable to get the vaccine to protect them from the measles. If vaccination rates do not improve, we may very well see case numbers approach historical highs present before the vaccine was used.

References

http://www.cdc.gov/measles/about/overview.html

http://www.cdc.gov/measles/about/transmission.html

http://wwwnc.cdc.gov/eid/article/12/4/et-1204_article.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a3.htm?s_cid=mm6104a3_w

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122md.htm?s_cid=mm6122md_w

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm?s_cid=mm6115a1_w

http://www.who.int/mediacentre/factsheets/fs286/en/

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6047a1.htm

http://www.niaid.nih.gov/topics/pages/communityimmunity.aspx

http://www.cdc.gov/measles/travelers.html

http://www.cdc.gov/vaccinesafety/Vaccines/MMR/MMR.html

http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Protect-Children-from-Vaccine-Preventable-Diseases-Including-Measles-.aspx

http://www.immunizationinfo.org/vaccines/measles

 

Comments

  1. #1 Anon
    June 22, 2012

    We’re on the long tail end of a Bordetella pertussis outbreak here. I work in a lab that does PCR testing for several things; we were doing about 10 B. pertussis samples a day for quite a while, but it was up to about 70 before I started, and then I came in one morning after about a month on the job and there were 145. If I was purely money-motivated, I’d be anti-vaccine – I was raking in the overtime for a while there. But I know there were children getting really sick and babies suffocating on the other end, so anti-vaxxers really piss me off now.

    If there were some negative consequences for risking all of your neighbors’ children, I think it wouldn’t piss me off quite so much. Maybe requiring quarantine if you try to come into the US without proof of vaccination. Maybe allowing/encouraging insurance companies to add a non-vaccinating surcharge (hey, the healthier you are, the less the insurance company pays for you – and anti-vaxxers cost everyone money and health). Maybe not allowing child tax credits to people who endanger everybody else.

    My second thought was that, ironically, anti-vaccination rhetoric may lead to increased use of vaccination – measles, mumps, rubella, and some other infectious diseases are candidates for elimination, like smallpox. But as long as the vaccination rates aren’t high enough, we need to keep vaccinating, at least the children of sane parents who believe in evidence-based medicine.

  2. […] through the air when an infected person coughs or sneezes making measles … Read more on ScienceBlogs (blog) This entry was posted in Geen categorie and tagged could, decision, delays, drug, Gilead, prevent […]

  3. #3 Stephanie
    September 19, 2012

    You might be pro-vaccine, but I’m totally against it.

    I distinctly remember getting vaccinated for all of those horrible childhood diseases. I remember because I screamed my head off and wouldn’t calm down and my mother slapped me across the face. (I have very distinct memories of early childhood back to six months old).

    At the age of 4 years old (after having been subjected to all of those vaccines that were supposed to keep me healthy) I had every childhood disease known one right after another. We were quarantined for an entire year and I ended up with Scarlett Fever on top of it. And had asthma as a result.

    So, tell me the vaccines they gave were bad, or tell me that I was given a placebo in some kind of government experiment or something. Just don’t try and tell me that vaccines are good for you!

    I’ve had two flu shots in my entire life. Both times I ended up with pneumonia and every time I get around someone that has had a recent flu vaccine I get sick.

    Now I can get around people with the normal flu and not have a sniffle, but get me around someone who has had a recent vaccine and it about does me in.

    I’ve never been diagnosed as immune compromised, but I’m tellin’ you right now that if measles cause shingles, all of those shingles and measles vaccines are probably causing the outbreak. I won’t go near any of the places that offer them either.

    Herd immunity is a great idea if you are willing to suffer the consequences of the vaccines. My fiance can’t take vaccines because it makes him collapse for some reason. Found that out in the military. So together, we are safer than most.

  4. […] Klostermann. ‘Is history repeating itself?‘ […]

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