My 4-year-old has taught me a little rhyme they sing at her daycare whenever it rains. It goes something like this:
Rain, rain go away,
Come again another day
It seems to me that if you replace “rain” with any of the vaccine-preventable diseases names, that first line captures the science-based, pro-health position quite well. We want these killer diseases to go away. It also seems to me that the second line captures the anti-vaxer’s position quite well too: they seem to want these vaccine-preventable diseases to come back. According to them these diseases are “harmless”, “rites of passage”, and they “go away on their own”. Some of them even have little parties where they intentionally try to infect their children with a vaccine-preventable disease by exposing them to other sick children, in order to build “natural immunity” which they perceive to be a better thing than the “unnatural” vaccine-induced one.
If we allow them to succeed that second line will come true; the diseases will start coming back.
In fact, we’re getting a preview of such a comeback today. As you read this, there are pockets of measles outbreaks in developed countries such as: the U.S., France, Belgium, Australia, Germany, Italy, as well as in developing countries such as Somalia and Congo. Measles is extremely contagious. About 90% of people with no immunity to it (i.e. did not get the disease and survived it, or did not get immunity from a vaccine) get infected if exposed. It is also not as harmless as some people might try to portray. According to the CDC:As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.
In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children. Measles kills almost 1 million children in the world each year.
On the other hand measles is highly preventable via the MMR vaccine, which is available to all in the developed world. So why are we seeing so many cases? The answer may not be straightforward, but at least in some cases the outbreaks are directly linked to unvaccinated people exporting the disease while traveling abroad. Here’s a summary, albeit incomplete, of worldwide measles activity so far in 2011.
U.S.
Minnesota
As of April 15th, 2011 the Minnesota Department of Health has confirmed 20 measles cases. The outbreak started when an unvaccinated child contracted the disease while traveling to Kenya. Sixteen other cases are directly related to this child (for a total of 17 related cases, confirming the incredibly high contagion rate for this disease). Another case contracted the disease while traveling to India; the 19th while traveling to Florida, while the 20th is of unknown origin. There have been 13 hospitalizations, and luckily no deaths. According to the Minnesota Department of Health:
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Six of the cases were too young to receive the vaccine
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Eight were of age but were not vaccinated
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One was vaccinated
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One was vaccinated prior to the recommended age
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Four have unknown vaccination status
You might be thinking: 20 cases, big deal! If you are, consider this: Minnesota has seen a total of 22 measles cases in the 14 year period from 1997-2010. That’s right, in a little over 3 months Minnesota has seen almost as many measles infections as in the previous 14 years combined.
Utah
5 cases of measles have been confirmed in what is shaping up to be the worst measles outbreak in Utah in a decade (although still small and limited to Salt Lake County). Four schools have been affected by the outbreak, and a total of 42 students have been identified for possible exposure. The first confirmed case was an Olympus High student who tested positive after returning from a trip to Europe. At least two other confirmed cases are linked to this teen; one was hospitalized. None of the confirmed cases had received the measles vaccine. The last suspected case of measles in Utah was in 2005, and the last outbreak was in 2000 in Summit County, which totaled 3 cases.
Elsewhere in the U.S.
A 9-month-old baby contracted the measles while traveling abroad and triggered a measles warning in a Long Island (NY) mall. The child was too young and most probably had not received the first dose of the MMR which is given at age 1.
A 24-year-old woman returning from a trip overseas sparked a mini outbreak in Boston at the French Consulate where she worked. 180 people were vaccinated in the hopes of containing the possible spread of the infection. I have been unable to verify the vaccination status of the 24-year-old woman.
Outside of the U.S.
The Democratic Republic of Congo has been battling a deadly outbreak since late 2010. So far, the disease has sickened over 21,000 and killed at least 210. One hundred and six of the dead are being reported to have been children less than 5 years of age. A massive Medecins Sans Frontieres (Doctors Without Borders) aid campaign has been underway since September 2010. Over 1.5 million children have been vaccinated so far, but it appears the epidemic hasn’t been contained yet.
Unfounded fears that the measles vaccine causes HIV/AIDS have led to a measles outbreak in Somalia. The WHO has reported at least 200 cases and a minimum of 11 deaths. Interestingly, a high percentage of the Minnesota measles cases are from the Somali community and unvaccinated, a community with which Andrew Wakefield has had close contact with.
An outbreak of measles in Cote d'Ivoire has sickened 47 and resulted in at least one death. The majority of the cases were in children under 5 years of age (78.7%) and the majority of cases were in unvaccinated individuals (87.2%, although to be clear this last number doesn’t mean much unless we know overall measles vaccination rates in the country). The outbreak gave rise to a massive immunization drive in February which targeted 500,000 children under 5. The confirmed numbers of measles cases in Cote d'Ivoire has been rising over the past few years: 22 cases were confirmed in 2008, 183 in 2009 and 433 in 2010.A massive vaccination campaign in the Philippines started in the beginning of April in response to increases in measles and German measles (rubella) cases over the past few years. The number of infections has grown from 453 in 2007 to 1,418 in 2010. More than 70 percent of these cases were among children who had not been vaccinated against measles.
Measles outbreaks are being reported in Europe, especially in Denmark, Bulgaria, France, Italy, Netherlands and Germany among others. Thirty European countries are reporting elevated levels of measles infection, with over 6,500 total cases reported. France alone has reported almost 5,000 cases so far this year (almost equaling the total from 2010). Belgium has recorded 100 in 2011 (as compared with 40 total for the whole of 2010) and most of the cases are in unvaccinated children (either too young to have received the vaccine or who skipped it). Other significant outbreaks are also taking place in Serbia, Spain (Andalusia), the former Yugoslav Republic of Macedonia and Turkey. The UK’s Health Protection Agency has issued a warning to travelers and is advising them to ensure their children are up to date with their MMR vaccine prior to heading to these countries for Easter. A similar warning has been issued by Health Protection Scotland to its citizens planning to travel to France.Australia is also reporting elevated measles cases. New South Wales has reported 29 cases so far this year. Seven of these cases were directly linked with unvaccinated or partially vaccinated travelers returning from overseas. Queensland is reporting 12 cases (compared with a total of 14 for 2010), two of which required hospitalization. Victoria's Health Department has issued a measles alert after four people were infected on a flight from Malaysia to Melbourne. The department believes more people may have been infected; over 90% of attendees have been telephoned so far, and about half of those have been asked to return this weekend for vaccination.
ConclusionIt is easy to become complacent and to get tired of being told how dangerous vaccine-preventable diseases can be. Yet, we’d be playing in the hands of the anti-vaccine proponents if we let ourselves get too lazy with our skepticism, and allowed them to convince us that all what I described above is no big deal. If we allow them to continue spreading their misinformation unopposed measles will come back; whooping cough will come back; polio will come back; untold death and suffering will come back. With little pockets of outbreaks the world over, a reduction in vaccination rates below herd immunity requirements is a recipe for disaster. The next outbreak is literally one airplane flight away, and we simply cannot afford to slack off now.
Support those of us who are fighting the good fight; support us and others like us in the anti-anti-vax camp. You know you don’t want “too many, too soon” to apply to children’s lives.
Leart Shaka is a NYC based skeptic, who is focusing his skeptical efforts in countering anti-vaccine misinformation. He is the creator, and Editor-In-Chief, of The Vaccine Times, a quarterly pro-health publication, for parents, by parents, and runs the Vaccine Times website and blog. He can be found on Twitter as @Skepdude and @VaccineTimes.
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