Category: Vaccine Preventable Diseases

When Measles Epidemics Would Close Schools

Remember when measles epidemics and outbreaks used to close down entire schools and school districts?

No, I don’t either, but of course, like many of us, I’ve been fortunate enough to have grown up in the post-vaccine era for measles and many other vaccine-preventable diseases.

When Measles Epidemics Would Close Schools

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.
Schools in California were closed for at least two weeks because of measles epidemics. Red Bluff Daily News, April 14, 1917

On April 16, 1917, as measles epidemics swept the United States, grammar schools in Red Bluff, California would shut down for at least two weeks.

Why?

Officials found that it was “impossible to cope with measles under present conditions” and they hoped this would help end the epidemic.

The city board of health also urged parents to “use every effort to stamp out the spread of the disease by keeping children at home, by having no child attend picture shows or even Sunday schools.”

This was hardly an isolated event though. School officials in Los Molinos and Redding, California had closed their high school and all grammar schools in late March for two weeks in the hopes “that the disease will wiped out in that time.”

Why the big push to end the outbreaks?

As experts warned that measles dangers were “too generally disregarded” by some, they also knew that “over 11,000 American children died of measles in 1910” and that “this did not include a large number who died of broncho-pneumonia.”

Tragically, there were many deaths in the 1917 measles epidemic too.

In nearby Chico, California, a mother and her 8-year-old died on the same day, while seven other family members were seriously ill and it was stated that “little hope is held for their recovery.”

Schools in Red Bluff didn’t open again until May 7, when finally the “epidemic of measles seems to have lessened its grip.”

Measles Were Never Marvelous

Some folks like to use the fact that there was a Brady Bunch episode about measles to make it seem like it was a mild disease.

If that’s true, then why do old newspaper clippings describe the “scourge of measles” and repeatedly warn how deadly it can be?

“Measles is often fatal to children under five years of age and on this account, special protection should be given to very young children. It is a mistake to expose a child to the disease so that he may “get ’em and have ’em over with.” The after results may effect the health of the individual all through his life.”

Red Bluff Daily News, Epidemic Measles Is Sweeping Over State California

Why were schools closed for three weeks?

Why did so many people die?

While some folks will blame it on a lack of modern medical care, poor nutrition, or poor sanitation back in the early 20th Century, you don’t have to go back that far to find reports of a lot of people dying of measles in the United States.

Even as improved nutrition, sanitation, and health care made many things less deadly, in the pre-vaccine era, in the late-1950s, there were about 450 measles deaths each year in the United States.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.

And at a time of modern nutrition, sanitation, and health care, at least 123 people died in the United States during the large measles epidemic from 1989 to 1991. Another 11,000 were hospitalized, among only about 55,000 cases.

“Two major causes of this epidemic were vaccine failure among a small percentage of school-aged children who had received 1 dose of measles vaccine and low measles vaccine coverage among preschool-aged children”

Dr. Walter Orenstein on the 1989-91 Measles Epidemics

Instead of “mild,” during the 1989-91 epidemics, you were more likely to hear terms like measles “emergency alert,” “Real Crisis Situation,” and “serious problem.”

Measles Still Keeps Kids From School

Fortunately, measles doesn’t close schools anymore. But not because measles has become more mild or easier to treat, after all, there is still no treatment for measles, but rather because most folks are vaccinated.

It can still lead to quarantines for those who aren’t vaccinated though. It is one of the ways that health officials work to control outbreaks.

During the Disneyland measles outbreak in California in 2015, a day care center in Santa Monica was closed (and 30 babies were put in home quarantine) and kids were kept from school at:

  • Amelia Earhart Middle School in Riverside – at least 6 unvaccinated students were kept from school after another student contracted measles
  • Palm Desert High School – 66 students were excluded from school because they are not fully vaccinated against measles
  • Huntington Beach High School – at least 24 unvaccinated students were excluded from school

But you don’t even have to go back that far to find these types of quarantines. In March, an unvaccinated student with measles led to the quarantine and exclusion of 7 other unvaccinated students from Laguna Beach High School in Orange County, California.

But a three week ‘vacation’ is hardly the worse thing that can happen when a measles outbreak comes to town. Measles is still deadly, even today.

Get educated and get vaccinated.

What To Know About When Measles Epidemics Would Close Schools

While you likely don’t remember when large epidemics of measles would close schools, it’s a reminder that measles wasn’t thought of as the mild disease that some claim it was.

More Information About History of Measles Epidemics

Hepatitis A Outbreaks

The hepatitis A vaccine, introduced in 1996, worked to decrease the incidence of hepatitis A infections in the United States.
The hepatitis A vaccine, introduced in 1996, worked to decrease the incidence of hepatitis A infections in the United States. Source – CDC Division of Viral Hepatitis

Hepatitis A is a now vaccine-preventable disease thanks to the hepatitis A vaccine that was first licensed in 1995.

Despite being added to the childhood immunization schedule in 1996 (kids living in high risk areas at first and gradually expanded to all kids in 2006), we do continue to see outbreaks of hepatitis A.

Hepatitis A

Although they are all viruses that can cause hepatitis, hepatitis A doesn’t share too much in common with hepatitis B and C.

Unlike hepatitis B and C, hepatitis A:

  • often doesn’t cause any symptoms at all in very young children
  • is spread by fecal-oral transmission (not blood and body fluids), typically from one person to another or after eating or drinking contaminated food or water
  • is much less likely to cause complications, but still did cause over 100 deaths from fulminant hepatitis A each year

In older children and adults, they symptoms of hepatitis A can include jaundice, fever, malaise, anorexia, nausea, abdominal discomfort, and dark urine, all of which can linger for up to two to six months.

Hepatitis A Epidemics and Outbreaks

In the prevaccine era, before the mid-1990s, hepatitis A outbreaks were common and “hepatitis A occurred in large nationwide epidemics”

After it became a nationally reportable disease in 1966, we saw peaks of hepatitis A disease in the early 1970s and again in the early 1990s and an estimated 180,000 infections per year in the United States.

Not surprisingly, those large nationwide epidemics soon disappeared as hepatitis A vaccination rates rose.

“Vaccination of high risk groups and public health measures have significantly reduced the number of overall hepatitis A cases and fulminant HAV cases. Nonetheless, hepatitis A results in substantial morbidity, with associated costs caused by medical care and work loss.”

CDC on the Epidemiology and Prevention of Vaccine-Preventable Diseases

We do still see some hepatitis A outbreaks though, including:

  • a multistate outbreak in 2016 linked to frozen strawberries (143 cases and 56 hospitalizations)
  • an outbreak in Hawaii in 2016 linked to raw scallops (292 cases and 74 hospitalizations)
  • a multistate outbreak in 2013 linked to pomegranate seeds from Turkey (162 cases and 71 hospitalizations)

So you can get hepatitis A if you are not immune and you are caught up in one of these outbreaks. Still, hepatitis A cases are at historic lows, with about 1,390 cases being reported in 2015.

Even more commonly, you might get hepatitis A if you are not immune and travel to a part of the world where hepatitis A either has high or intermediate endemicity (many people are infected), including many parts of Africa, Mexico, Central and South America, Eastern Europe, and Asia.

Or you could just be exposed to someone who traveled to or from one of these areas, became infected, and is still contagious.

There have also been outbreaks among men having sex with men, among IV drug users, and the homeless. These outbreaks are often the most deadly, and include fatal outbreaks in Michigan, California, and Colorado.

Avoiding Hepatitis A

How can you avoid getting caught up in one of these hepatitis A outbreaks?

Get vaccinated.

Can’t you just wash your hands or avoid eating contaminated food? Since you can get hepatitis A by simply eating food that has been prepared by someone who has hepatitis A and is still contagious, washing your own hands won’t be enough. Even drinking bottled water when traveling might not protect you from contaminated water if you use ice cubes or wash fruits and vegetables in water that might be contaminated.

Remember, if your child did not get a routine 2-dose series of the hepatitis A vaccine when they were between 12 to 23 months old, they can still get one at any time to get immunity against hepatitis A infections.

“On February 25, 2009, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis A vaccination for household members and other close personal contacts (e.g., regular babysitters) of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.”

ACIP on the  Latest Hepatitis A Vaccine Recommendations

Adults can get the vaccine too. It is an especially good idea if you are not immune and will be traveling out of the United States or are in another risk group, including food handlers, daycare workers, health care workers, and people who consume high risk foods, especially raw shellfish.

What to Know About Hepatitis A Outbreaks

Although we are at historic lows for cases of hepatitis A, make sure that your family has been vaccinated against hepatitis A so that they don’t get caught up in the next outbreak.

More Information on Hepatitis A Outbreaks:

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Vaccine-Preventable Diseases

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Today, in the United States, children typically get:

  • 36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.

While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Vaccine-Preventable Diseases

Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.

Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:

  1. adenovirus – a military vaccine
  2. anthrax – vaccine only given if high risk
  3. chicken pox – (Varivax, MMRV)
  4. cholera – vaccine only given if high risk
  5. dengue – vaccine not available in the United States
  6. diphtheria – (DTaP/Tdap)
  7. hepatitis A – (HepA)
  8. hepatitis B – (HepB)
  9. hepatitis E – vaccine not available in the United States
  10. Hib – (Hib)
  11. HPV – (Gardasil)
  12. Haemophilus influenzae type b – (Hib)
  13. measles – (MMR, MMRV)
  14. meningococcal disease – (MCV4 and MenB and MenC)
  15. mumps
  16. pneumococcal disease – (Prevnar13 and PneumoVax23)
  17. pertussis – (DTaP/Tdap)
  18. polio – (bOPV and IPV)
  19. Q-fever – vaccine not available in the United States
  20. rabies – vaccine only given if high risk
  21. rotavirus – (RV1, RV5)
  22. rubella – (MMR, MMRV)
  23. shingles – vaccine only given to seniors
  24. smallpox – eradicated
  25. tetanus – (DTaP/Tdap)
  26. tick-borne encephalitis – vaccine not available in the United States
  27. tuberculosis – (BCG) – vaccine only given if high risk
  28. typhoid fever – vaccine only given if high risk
  29. yellow fever – vaccine only given if high risk

Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.

These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.

What To Know About Vaccine Preventable Diseases

Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.

More About Vaccine Preventable Diseases

Obstetric Tetanus Is Still a Thing in the United States

Yes, even though we have had a tetanus vaccine for over 80 years, obstetric tetanus is still a thing in the United States.

Obstetric Tetanus in Kentucky

According to a report from the CDC, in July 2016, an unvaccinated Amish woman in Kentucky developed “facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing” about nine days after “she delivered a child at home, assisted by an unlicensed community childbirth assistant.”

She  was hospitalized for a month, during which time she had seizures and was on a mechanical ventilator to help her breath for a “prolonged” amount of time.

Fortunately, her baby didn’t also develop tetanus, even though the family refused a recommended dose of tetanus immunoglobulin that could prevent neonatal tetanus from developing.

Surprisingly, after this incident, only 12% of community members agreed to be vaccinated with a tetanus vaccine. One pregnant woman even refused to get vaccinated. This is even less than the response to the Ohio measles outbreak in 2014, when up to 28% of unvaccinated Amish members got vaccinated with an MMR vaccine.

Neonatal Tetanus

An 8-day old baby with neonatal tetanus born to an unvaccinated mother.
An 8-day old baby with neonatal tetanus born to an unvaccinated mother. (CC BY 3.0)

In addition to obstetric tetanus, getting tetanus during or right after a pregnancy, neonatal tetanus is a big concern for unvaccinated mothers. Just like if their mothers don’t get a flu or pertussis containing vaccine, without a tetanus vaccine, newborn babies don’t get any passive immunity and protection against tetanus.

In 2015, 34,019 newborns died from neonatal tetanus worldwide. Amazingly, that is down from 787,000 newborns in 1988 “through immunization of children, mothers, other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices.”

It is not all about hygiene though. Tetanus spores are everywhere. For example, in the Kentucky case, the CDC found no evidence of “birth trauma, unsterile conditions, or other complications.”

In Montana, the baby of an unvaccinated mother developed tetanus that was linked to a non-sterile clay that was given to them by a midwife for home umbilical cord care.

Fortunately, these kinds of cases are rare. There have probably been less than 40 cases of neonatal tetanus since the early 1970s, and only two since 1989, but they should still be a reminder of what could happen if we stop getting vaccinated.

Risky Umbilical Cord Practices

Adding to the risk of getting tetanus, the same moms who aren’t getting vaccinated and protected may be following unsafe umbilical cord care practices.

“…tetanus in neonates can result from umbilical cord colonization, particularly in countries with limited resources. This infection results from contamination of the umbilical separation site by Clostridium tetani acquired from a nonsterile device used to separate the umbilical cord during the peripartum period or from application of unhygienic substances to the cord stump.”

AAP – Umbilical Cord Care in the Newborn Infant – 2016

In countries that are still combating neonatal tetanus, we hear of mothers in rural areas  putting herbs, herbal pastes, chalk, powders, clay, oils, and even butter on their baby’s umbilical cord.

These natural substances are certainly not safer than more standard care, as they can be contaminated with something else that is natural – tetanus spores.

What natural things, and risky, things can you see recommended for umbilical cord care in developed countries? How about honey, goldenseal powder, Frankincense and myrrh oil, and Aztec Healing Clay?

You don’t feed honey to infants because of the risk of botulism spores, but you are supposed to put it directly on their umbilical stump?

Some midwifes even recommend ground rosemary or other dried herbs that you are actually supposed to sprinkle directly on your baby’s umbilical stump. The use of dried herbs is especially problematic. It is well known that these products are not sterile.

“Spore forming bacteria (B. cereus, C. perfringens) that are capable of causing foodborne disease when ingested in large numbers are frequently found in spices and herbs, but usually at low levels.”

Food Microbiology. Volume 26, Issue 1, February 2009, Pages 39–43

If dried herbs are also contaminated with tetanus spores (C. tetani), and you place them on an umbilical cord stump of a child whose mother wasn’t vaccinated against tetanus, then you unnecessarily increase the risk for neonatal tetanus.

Not that you would ever hear about this risk from anyone who pushes these practices or tells these moms to avoid getting vaccinated. What happened to informed consent?

And what happens as Andrew Wakefield‘s kids continue to grow up, move beyond getting measles, and begin to have kids? If they still aren’t vaccinated, they and their babies will be at risk for diseases that we thought we had gotten well controlled, like obstetric tetanus, neonatal tetanus, and congenital rubella syndrome.

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Hedda Get Bedda Doll and Other Measles Stories

Hedda Get Bedda originally came with a hospital bed.
The Hedda Get Bedda doll originally came with a hospital bed.

In the early 1960s, the American Character Doll Company produced a series of Whimsie dolls, including:

  • Annie the Astronut
  • Fanny the Flapper
  • Hilda the Hillbilly
  • Lena the Cleaner (baseball)
  • Samson the Strongman
  • Simon the Degree
  • Wheeler the Dealer (casino dealer)
  • Zero the Hero

Hardly politically correct for our times, the stereotyped dolls do provide a look at the history of their time.

One other doll, Hedda Get Bedda, is especially helpful in that sense.

Made in 1961, this Whimsie doll could change her face, letting you know how she was feeling when you turned the knob on her head. She could go from having a sleeping face, to a sick face (perhaps having chicken pox or measles), to a happy face (once you made her better).

Does the fact that she also came with a hospital bed mean anything?

Just like some anti-vaccine folks like to think that the simple fact that they made a doll that had measles or chicken pox could possibly mean that they looked at them as mild diseases, you could just as easily say that including the hospital bed means ‘they’ understand they were life-threatening diseases that could put land you in the hospital.

We are talking about the pre-vaccine era after all, and in 1961, and when the Hedda Get Bedda doll came out, there were about 503,282 cases of measles in the United States and 432 measles deaths.

Like the Brady Bunch measles episode, the Hedda Get Bedda doll is sometimes used to push the myth that vaccine-preventable diseases aren’t that serious, helping folks justify their decisions to intentionally skip or delay vaccines and leaving their kids unprotected.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

For example, if you believed that measles, chicken pox, or Hib were mild diseases, then you might feel better about not getting your child the MMR, chicken pox, or Hib vaccines.

Sure, many people get measles and do get better without any complications. On their way to getting better though, even they have high, hard to control fever for 5 to 7 days, with coughing and extreme irritability.

But while most get better, we shouldn’t forget that some people don’t survive measles without complications. Natural immunity sometimes comes with a price, from vision problems and permanent hearing loss to brain damage.

And tragically, some people don’t get to survive measles.

Get Educated. Get Vaccinated.

For More Information and Measles Stories