I wrote several posts on mumps outbreak here in Iowa this past spring. However, we aren't the only I-state to have dealt recently with an outbreak of vaccine-preventable disease. An editorial in yesterday's New York Times highlights the dangers of withholding vaccincations.
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In the spring of 2005, an outbreak of measles occurred in Indiana. The unvaccinated index case had been traveling in Romania on a missionary trip, where she picked up the virus. Measles is one of the most infectious viruses we know of, and when she returned home, she ended up spreading the virus to at least 34 others during a church gathering. All except two of these secondary cases were completely unvaccinated for measles, and while many people consider measles to be a merely annoying childhood disease, three of the cases were serious enough to require hospitalilzation. The editorial notes that:
Most had been schooled at home and thus avoided compulsory shots. Their families had access to the vaccine but declined the opportunity because of reports that it might cause autism or other problems. Their fears overrode assurances by health authorities that the vaccine is extremely safe and has no link to autism.
I'm a parent myself, and I know that the administration of any kind of shot to your child can be a scary thing. But the evidence is overwhelmingly against any kind of link between vaccines and autism. The original paper linking the MMR (measles, mumps, and rubella) vaccine to autism has been totally discredited, and the lead author faces charges for unprofessional conduct. Meanwhile, the father-son team who've led the charge against vaccines here in the U.S. may be even more unethical, creating their own institutional review board to give approval to their own studies.
The result of this scare campaign certainly can be loss of human life. Though measles cases remain low in the U.S. due to overall high vaccination coverage, in the developing world, measles remains a huge scourge, though vaccination has made a big dent in morbidity and mortality due to the virus:
In 1999, measles still caused 873,000 deaths per year, and accounts for almost half of the 1.6 million vaccine-preventable deaths in children every year. The Red Cross and associated agencies began a campaign in 2000 to reduce this number, akin to the polio and smallpox eradication efforts. They concentrated on sub-Saharan Africa, where 95% of the measles deaths worldwide occurred. By 2003, deaths were already down by 39% (to just over 500,000 in that year). Still, 500,000 vaccine-preventable deaths every year is way too many. And resistance to this vaccination remains, and by some accounts, is growing, in the United States. People forget that these "benign childhood diseases" can, and do, kill, and that vaccines are a public health intervention that has saved many millions of lives around the world.
The editorial ends by noting that we all need to take part in order for maximum benefit from these vaccines:
Families that evade vaccination put themselves and their neighbors at risk. All young children, not just those attending school, should be required to get immunized.
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I would encourage everyone to read the actual August 3rd NEJM publication which is currently available free. Two of the "hospitalizations" were for IV rehydration (so was this just an ER visit, or an actual admission?). The third was a smoker who developed pneumonia as a secondary complication and required a ventilator for a week. If find it ironic that she was the hospital's phlebotomist and at age 34 only had one dose of measles vaccine as an infant -- wouldn't she be someone you would want to have up to date vaccinations?
As far as measles in under developed countries, it is my understanding that Vitamin A deficiency largely contributes to the complication and mortality rate of the measles. The countries where the majority of these cases are occurring are suffering from poverty, famine and war. Does anyone really believe that a measles vaccine is what they need to cure them of this disease?
To clarify, I do not believe the MMR causes autism. But I do believe that parent's should have the right to make vaccination choices for their children. And as this measles outbreak demonstrated, 33 of the 34 infected had not received 2 doses of measles vaccine. There was only 1 case of true "vaccine failure" despite an exposure of over 500 people. Parent's should feel confident in their children's vaccine efficacy.
I meant to include the NEJM article; it's here.
They don't specifically say if the 3 cases were admitted; they use the term "hospitalized," as does the MMWR article on the outbreak.
Indeed, vitamin A deficiency leads to increased mortality from measles and other diseases, including malaria and diarrheal diseases. But you're presenting an either-or scenario here. Increasing measles vaccination rates protects them for a lifetime, while vitamin A supplementation must be repeated 2-3 times a year. Of course, decreasing poverty and increasing nutrition and basic public health infrastructure are more ideal long-term fixes, but increasing vaccination coverage provides immediate protection against a serious disease.
Thanks for beating the immunization drum again Tara, but I disagree with you on one thing:
To quote:
I'm a parent myself, and I know that the administration of any kind of shot to your child can be a scary thing.
Well, I'm the parent of two, and I had absolutely no problem getting them stuck for every single solitary vaccine recommended. For the first couple of years, yes, they cried -- I didn't. When they were older, and had absorbed my stories about how nasty these diseases really were (Mom's a doctor, so we had lots of good stories), they stopped fussing at all. Now when the youngest gets her annual flu shot, she's laughing while it goes in.
We need to get across a key point: vaccines are like discipline -- not easy to do at the time, but well worth it.
I go back and forth between saying that parents should be able to choose not to vaccinate their kids, in effect, changing natural selection into self selection.
On the other hand, there is no reason to put a kid in the position of catching an easily preventable disease.
A friend of mine blames her kid's learning disability on vaccines. She ignores the fact that her husband has a less severe form of the same disability.
Tara,
In a random conversation in which I talked to somebody on a plane (and have little fact), that person mentioned recently having a case of the Mumps (I assume from Michigan). This person mentioned explicitly checking for MMR immunization record and even had record of a Titer check when this person worked in a hospital.
This immediatley raised concerns with me that that either this was resistent (less likely) or that the immunization effect drops off. Any comments?
There's an ongoing study examining just that question, using some patients and viral samples from the recent mumps outbreak here in Iowa. They're also looking into whether the circulating virus was different enough from the vaccine strain that the vaccine didn't provide enough cross-protective immunity to protect even those who were effectively immunized from infection. I'm not involved in the research so I don't know what they've found so far, though.
If we demand by law that parents use car seats for infants, we can also demand that they vaccinate them.
Simple as that.