Effect Measure

Measles patient zero: 17 years old

Measles is now uncommon in the US, thanks to vaccination. Last year there were only 66 cases. But half of them came from a single, unvaccinated 17 year old who traveled to Romania on a church mission that visited an orphanage. The next day she returned to the US and attended a gathering of other church members, 33 from Indiana and one from Illinois. Three wound up in the hospital.

Measles vaccination is not 100% effective but it is estimated to be over 90% in pre-school and school aged children. In this instance, 32 of the 34 cases were unvaccinated:

“The outbreak occurred because measles was imported into a population of children whose parents had chosen not to vaccinate their children because of safety concerns, despite evidence that measles-containing vaccine is safe and effective,” the CDC said.

Nearly all of the 32 other U.S. cases in 2005 originated abroad, including 16 involving U.S. residents infected while traveling overseas and seven involving foreigners who were infected before visiting the United States. (AP)

The obvious lesson here is that measles vaccination is extremely important. Children should be vaccinated at 12 – 15 months and again prior to entering school. Measles infections during pregnancy can result in spontaneous abortion, premature labor and low birth weight. While most people are not affected fatally, in my youth, before the vaccine, there were an average of 400,000 clinical cases a year and undoubtedly many more, perhaps ten times as much, unrecognized or subclinical cases. There were on average over 120 deaths, triple the number of total cases we see now in the post vaccine era. The economic costs of those 400,000 cases was also substantial, not only in the costs of medical care and hospitalizations, but in lost work and school time for caregivers and the children themselves.

But there is another lesson, the one about international travel and the spread of infectious diseases from a Romanian orphanage to the heartland of America in just one day and via one person. It didn’t result in a huge measles outbreak because most Americans have been vaccinated (our vaccination rate is over 90%). That’s the product of a public health system. When we cut public health we also cut into programs like immunization and prenatal programs.

I think you know where I’m going on this.

Comments

  1. #1 Tony P
    December 25, 2006

    Wasn’t there some concern that the mercury based preservative thimerosal was one of the prime autism culprits? I mean I smelled the bovine effluent when I first heard about that, but many people aren’t smart enough to realize that we take in so much mercury through other sources.

    Vaccination is a critical need. Hopefully a virulent strain of measles will whip through the U.S. killing off all the idiots.

  2. #2 revere
    December 25, 2006

    Tony: Turns out there never was thimerosol in the vaccine (a mistake I made once), although some parents might believe there is or was.

  3. #3 Mark
    December 25, 2006

    There may have been some chatter here and there :)

  4. #4 John Wilkins
    December 25, 2006

    I think you know where I’m going on this.

    It’s all caused by mercury poisoning?

  5. #5 neil
    December 26, 2006

    I think that while the threat of disease that CAN be prevented with vaccination, it should be MANDATORY that all at risk or all potentialy who might acquire and transmit these diseases be vaccinated.

    It’s a risk assesment issue, I think..,

    Back up the mandatory vaccination with better study of vaccine safety/risk then we might be able to wipe out some infectious diseases.

    Until then there will always be breakouts like this.

  6. #6 g510
    December 26, 2006

    Between the internet, cheap international phone rates, and the new broadband/satelllite radio and television services, you can see and hear and read and write and talk with almost any country on earth. You can conduct business deals, oversee a foreign factory, go on pleasure trips from your desktop, and chat with the local folks (many of whom speak English anyway).

    That leaves only three reasons to actually “go there.” Smell, taste, and touch. Each of which is a disease transmission path.

    What purpose to visit an orphanage? To sniff the babies? Taste their baby food? Pick them up in your own hands (and watch out that they don’t poop on you, good luck!)…?

    In this day & age you have to be frankly insane to engage in recreational travel, and at least mildly nuts to think that your presence “over there” will do any good for anyone that can’t be done by telecommunications means.

    Americans are basically ignorant of the realities of life elsewhere in the world, and all the tourist travel (including pious church visits that don’t involve long-term charitable work) hasn’t made an iota of difference in that department. They go hither and yon, glimpse the harsh realities of life everywhere else, and then neatly compartmentalize the memories as they return home to their McMansions and slip behind the wheels of their oxymoronically-named “sports” “utility” vehicles. And then they go back to cussing out the dark-skinned and non-English-speaking peoples of the world, with special exceptions for the “nice ones” met on those tourist trips.

    Meanwhile, microscopic hitch-hikers lurk waiting for opportunities.

    Dr. Darwin is gonna’ have a whole lot of fun this century.

  7. #7 crfullmoon
    December 26, 2006

    g510, I’d say, Mr.G.Reaper and Mother Nature as Kali will likely be very busy in the coming years, too.

    “In this day & age you have to be frankly insane to engage in recreational travel”

    Explain that to the unprepping loved ones who expect me to book a vacation this summer with them.

    Many think me frankly insane for having ceased unnecessary travel already. (Or, just don’t get that I have.) “Pandemic influenza may break out at any time” is not the same risk category as saying, it is not impossible that the Earth could get an asteroid strike, or, we might get a terrorist attack.” People don’t want to consider things may change for the worst even if they don’t look into pandemic more carefully than their media and local officials present it.

    Paying attention to Dr.Nabarro, and actually reading the govt/CDC/State Dept info,
    I don’t know how so many risk travel when they could be quarantined while a sick passenger is tested,
    or worse; get stranded somewhere when pandemic breaks out. Govt says they can’t give you any assistance, nor travel home. (For once, I believe them at face value!)

    Jet-setting retired loved ones are surprised I won’t make travel plans for a family reunion;
    “We don’t want to just Stop Living!”

    Neither do I. That’s why I can’t risk travel.

    I have no “black helicopters” at my beck and call that will get me home, (not that being home is much of a solution, but I have no Mt.Weather, either).

    We just seem to have different ideas of what “living” means, what the risks are, and how very unpleasant stopping living via H5N1 pandemic might be.
    I don’t want people to stop living because they are caught with thousands or millions of other stranded travellers, in civil unrest, with, no necessities or escape, nor any one stop living “because their lungs died first”.

    Religious franchises should not be travelling for photo and fundraising ops either. Don’t get me started.
    And vaxing put less toxins in people than our polluted food chain/environment does nowadays.
    What a world…

  8. #8 oddthomas
    December 26, 2006

    To g510: If you had read the article you would have noticed the individual in question was on a church field trip. There exists a lot of energetic Americans do field trips to help physically rebuild what the lazy nationals will not including, obviously, yourself. Rather than complain, why don’t you physically help out?

  9. #9 MoM
    December 26, 2006

    Neil said: I think that while the threat of disease that CAN be prevented with vaccination, it should be MANDATORY that all at risk or all potentialy who might acquire and transmit these diseases be vaccinated.

    MANDATORY??? Good Idea, and right after, we could mandate forced sterilization of everyone with a room temperature IQ.

    On second thought, as much as I believe in immunizations, I think I believe in personal freedom more.

    OTOH, we quarantine other (than human) animals as they enter the country. I could see a mandatory quarantine of a susceptable (unvaccinated) traveler from a region where a communicable disease was endemic until after 2 incubation periods.

    Problem with that is… what is the incubation period for HIV? (or vCJD, or anything else with no pre-exposure prophylaxis and a long incubation period.)
    MoM

  10. #10 Charles Roten
    December 27, 2006

    neil -

    The problem with mandatory vaccinations, besides the occasional hopelessly and impossibly flawed vaccine, is the fact that the inevitable blowback will probably end up by making that particular risk mitigation null and void.

    Neil, let me ask you a question which may not be so theoretical – unfortunately.

    Suppose the antivirus program on your Windows PC renders your system completely unusable for an unacceptable percentage of the time. What are you liable to do next? What will most people do?

    Right. They’ll turn the damned thing off. Because the way things are, their machine is out of commission anyway.

    People will find ways to “turn off” unbearably onerous public health measures, too.

    Wise leaders understand this and act accordingly.

    If memory serves, the most startlingly quick mass vaccination campaign in history, and arguably the most successful, the vaccination of more than 6 million New Yorkers in just a month in 1947, was undertaken without the use of official coercion.

    There are other ways to dice that particular cabbage. Ones more certain in their effectiveness and whose side effects are more containable. Like the Mayor getting very publicly vaccinated himself, for just one example.

    Like transparency of the effort and full disclosure of the extent of the threat, for another.