Monday, February 2, 2015

The Measles Outbreak and Vaccination

Most of you are probably well aware of the measles outbreak in Disneyland. At least 100 cases have been traced back to exposure at Disneyland. Although measles was declared to have been eliminated from the U.S. in 2000, the U.S. has been seeing an increase in measles the last several years. In March 2014, there were warnings that the U.S. could see more significant outbreaks.“Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die.”

 "Pediatric infectious disease specialist James Cherry told the New York Times the outbreak was '100 percent connected' to the anti-vaccine movement. 'It wouldn’t have happened otherwise — it wouldn’t have gone anywhere,' he said."  However, the same article reported that "in addition to vaccine refusal, there is another key reason measles is spreading in the US: the disease hasn't been eliminated everywhere, and it seems travelers to America are bringing measles with them." Thus, of 288 cases examined by the CDC in 2014, 280 (97%) were associated with importations from other countries. The article explains:
In an examination of 2014 measles outbreaks, the Centers for Disease Control and Prevention reported, "Of the 288 cases, 280 (97 percent) were associated with importations from at least 18 countries."  
Many of these travelers were coming back from the Philippines, which has been dealing with a massive outbreak since fall 2013.  
These travelers would not be getting sick, however, if they were vaccinated. According to the CDC, of the cases examined in 2014, 195 involved US residents who were unvaccinated. Eighty-five percent of these people had refused vaccination because of religious or personal beliefs. 
So Disneyland may have been the perfect incubator for a measles outbreak, with its mixture of international travelers and very young unimmunized children, in a state where vaccine refusal is not uncommon.
The measles vaccine is not licensed for use on babies younger than 12 months. That means that, for the first year of life, babies depend on the fact that everybody else around them gets vaccinated. This essentially creates a firewall: if other people are vaccinated, they won't catch the disease — and won't spread it to young children who cannot get protection. 
This is what scientists call "herd immunity," and its a huge reason we get vaccines in the first place. The shots aren't just about protecting ourselves from measles, mumps, the flu, or other diseases. They're about making it really hard for those who are medically frail (like the elderly) and those who can't get the vaccine (often babies and pregnant women) to catch a disease that could be devastating to them. The vaccinated people form something like a fence around the vulnerable people, making it extra hard for the disease to come in. 
At Disneyland, the fence wasn't high enough — and it didn't do a good enough job protecting babies against measles because there were too many people who didn't get vaccinated. 
As my colleague Julia Belluz has explained, this isn't just about Americans who refuse to get vaccinated, but also foreign travelers coming from countries dealing with outbreaks. In both cases, measles is the most dangerous to those who can't get protected against it.
(See also this article at Salon). The "firewall" is needed because not all children will develop an immunity, even if immunized; and others cannot be immunized.
[A]bout 3% of fully vaccinated children do not develop a lasting immune response. They have low blood titers and are not protected against measles. If exposed, this group will likely get the illness. I am in this group. I was thankfully not exposed.

Third, we have the unvaccinated. My son, Eli, is ten months old. He is too young to received the MMR vaccine and thus has no protection. Whether by refusal or because they are too young, exposed unvaccinated children have a 90% chance of getting measles.

Fourth, there are children like my Maggie. These are child who can’t be vaccinated. Children who have cancer. Children who are immunocompromised. Children who are truly allergic to a vaccine or part of a vaccine (i.e anaphylaxis to egg). These children remain at risk. They cannot be protected … except by vaccinating people around them. In August of 2014, Maggie was diagnosed with pre-B acute lymphoblastic leukemia, a form of childhood leukemia. We have been fighting leukemia since then.
The sad part is that parents who refuse to vaccinate their children are not only risking the health of the rest of us, but they are condemning their own children to a lifetime of needless illness and infections, so very serious and with long term consequences. For instance, Amy Parker writes at Slate:
I am the ’70s child of a health nut. I wasn’t vaccinated. I was brought up on an incredibly healthy diet: no sugar till I was 1, breastfed for over a year, organic homegrown vegetables, raw milk, no MSG, no additives, no aspartame. My mother used homeopathy, aromatherapy, osteopathy; we took daily supplements of vitamin C, echinacea, cod liver oil. 
I had an outdoor lifestyle; I grew up next to a farm in England’s Lake District, walked everywhere, did sports and danced twice a week, drank plenty of water. I wasn’t even allowed pop; even my fresh juice was watered down to protect my teeth, and I would’ve killed for white, shop-bought bread in my lunchbox once in a while and biscuits instead of fruit, like all the other kids. 
We ate (organic local) meat maybe once or twice a week, and my mother and father cooked everything from scratch—I have yet to taste a Findus crispy pancake, and oven chips (“fries,” to Americans) were reserved for those nights when Mum and Dad had friends over and we got a “treat.” 
As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of 7 that Mummy might have cancer before it was safely removed.
 My mother would have put most of my current “crunchy” friends to shame. She didn’t drink, she didn’t smoke, she didn’t do drugs, and we certainly weren’t allowed to watch whatever we wanted on telly or wear plastic shoes or any of that stuff. She lived alternative health. And you know what? I’m glad she gave us such a great diet. I’m glad that she cared about us in that way. 
But it just didn’t stop me getting childhood illnesses. 
My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got many illnesses requiring treatment with antibiotics. I developed penicillin-resistant quinsy at age 21—you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.
My father-in-law was also raised by parents who decided not to immunize their children. He tells a similar story of suffering childhood illnesses, a couple of which left him with permanent complications.

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