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.

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9 Comments

  1. I didn’t realize it had been declared eradicated. There were breakouts when I was in high school – we were in the age group that didn’t have the booster so even those of us who had been properly vaccinated according to the rules when we were babies weren’t immune. We all got shots as seniors in high school, too.

    I just had my third MMR shot a year ago because I didn’t test as having the protection against rubella.

    I wonder how many other people my age think they are properly covered and aren’t?

  2. Lynda M O

     /  October 30, 2011

    Interesting.

    Here in NorCalifornia we are witnessing an outbreak of Whooping Cough in kids and adults. My doctor explained that the lifetime immunity we thought we had gotten as kids is not lasting for a lifetime and so we have to be re-shot as it were in order to provide immunity. In my case, I deal with other people’s infants and children so I willingly went for the booster shot.

  3. Old Geezer

     /  October 30, 2011

    As you can tell by my moniker, I am no spring chicken. Back in the day, our cub scout pack took a field trip to Rancho Los Amigos, a hospital for the long-term care of polio patients. We were allowed to walk through seemingly endless wards of patients in iron lungs whose heads were the only things we could see. We had friends who died of various diseases. These made deep impressions upon our young minds. We had periodic mandatory inoculations provided by our public schools and there was no “opt out.” We just did it. On the other hand, I suppose there was some person somewhere who was convinced that it would make us crazy or sterile or something, but there was no magic communication box sitting in the living room that allowed instant communication with the world to propagate these ideas. Sometimes the ease of getting the message out overwhelms necessity of getting the message right.

  4. DLC

     /  October 31, 2011

    The other night I saw a local news program’s blub add for a news item : “are parents ordering diseases over the internet?” and a graphic on screen : a collage including a headline reading “measles parties?” Seriously… there’s parents out there who give their kids diseases ?
    Holy Freakin Crap!

    I just googled it. wikipedia entry follows: http://en.wikipedia.org/wiki/Pox_party
    wow. just… wow. are people this freakin nuts that they’ll force disease on their children in order to avoid a few seconds of discomfort that is most immunizations ? I don’t want to believe it.

  5. Back before chicken pox vaccination (like, when i was a kid) chicken pox parties made some sense (not much, but some) since getting out of the way when young was potentially safer than getting it as an adult. Given the modern alternative (real vaccination) it no longer makes sense. In fact, it’s pretty much child abuse.

  6. A few months ago, at DragonCon, I was on a panel about superstition. When I was preparing for it, literally reading the Oxford Dictionary of Superstition, I was struck by how damn many of the superstitions had to do with whooping cough. This disease was terrifying, and people knew that it was a matter of life or death. If you want to read about that, I wrote a thingy up on it at Skeptical Humanities.

    http://skepticalhumanities.com/2011/09/07/superstitions-as-a-window-into-culture-whooping-cough-cures/

  7. DLC

     /  October 31, 2011

    Back in the day, the chicken pox went through my grade school like a wildfire. I was miserable, but survived. But, what if I’d have been one of the number who suffer complications ? what if I’d had chicken pox AND another common illness ?

  8. Elissa

     /  November 2, 2011

    I’m in Australia, and I’m not sure what the measles situation is here, but I’m already afraid for my (still hypothetical) children. My babies will be very sheltered until they’ve had their first shots. It infuriates me that other people’s ignorance and credulity put innocent babies at risk.

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