Tag: elimination

Why Haven’t We Eradicated Measles Already?

The first measles vaccine was developed in 1963.

So why do we still have measles?

Shouldn’t measles be on the list with all of the other eradicated diseases, like smallpox and, well smallpox…

Why Haven’t We Eradicated Measles Already?

Eradicating a disease is not as simple as developing a vaccine.

If it were, a lot of diseases would have been eradicated already.

Hopefully, we will add more to the list of eradicated diseases, but there are some that will never be eradicated. Tetanus, for example, is ubiquitous in soil, so would be nearly impossible to eradicate. Other diseases, like rabies and yellow fever, would be hard to eradicate because they can infect animals or insects.

What about measles?

Anti-vaccine folks do not understand herd immunity.

While there was never a goal to eradicate measles by 1967, we have missed several deadlines to get measles under better control.

What was the first deadline?

“Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication.”

Measles Eradication: Recommendations from a Meeting Cosponsored by the World HealthOrganization, the Pan American Health Organization, and CDC

Folks started talking about measles eradication in 1996.

Before that though, there had been a goal to eliminate measles in the United States.

“An effort is underway to eliminate indigenous measles from the United States; a target date of October 1, 1982 has been set.”

Although we missed that initial target date, we weren’t too far off.

“In 1978, the US Public Health Service initiated a Measles Elimination Program with the goal of eliminating measles from the United States by 1982. The goals of this program included (1) maintenance of high levels of immunity,(2) careful surveillance of disease, and (3) aggressive control of outbreaks. Unfortunately, the program failed, predominantly because of the failure to implement the recommended vaccination strategy and because of vaccine failure. An increase in measles cases was sustained from 1983 through 1991 and was particularly dramatic from 1989 through 1991.”

Poland et al on Failure to Reach the Goal of Measles Elimination

There is also the fact that measles is just so dang contagious!

Improving vaccination rates and a two-dose MMR schedule helped decrease measles rates even further and finally eliminate the endemic spread of measles in the United States in 2000.

What were some other deadlines and goals?

  • In 1989, the World Health Assembly resolved to reduce measles morbidity and mortality by 90% and 95%, respectively, by 1995, compared with disease burden during the prevaccine era.
  • In 1990, the World Summit for Children adopted a goal of vaccinating 90% of children against measles by 2000.
  • Regional measles-elimination goals have been established in the American Region (AMR) by 2000, the European Region (EUR) by 2007, and the Eastern Mediterranean Region (EMR) by 2010.
  • A regional measles-elimination goals have been established in the Western Pacific (WPR) by 2012.
  • In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015 – the Region of the Americas, EUR, EMR, and WPR.
  • Countries in all six WHO regions have adopted goals for measles elimination by 2020.

Obviously, we haven’t hit all of the goals and deadlines on time.

What have we done?

We have tremendously reduced the number of children who get measles and who die with measles. For example, instead of meeting the 2010 goals of decreasing global measles mortality by 90% over 2000 levels, we have decreased it by 74%. The world has gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 million deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

There is still some work to be done though, especially with the uptick in cases and deaths in the last few years.

“Eradication of both measles and rubella is considered to be feasible, beneficial, and more cost-effective than high-level control.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review report: Background and summary

Work that we can still do if everyone makes the commitment to implement their elimination plans.

And folks vaccinate and protect their kids!

What’s the alternative?

To go back to when even more kids got sick and died with measles?

More on Eradicating Measles

More Measles Hysteria From Bob Sears

Most folks remember Dr. Bob’s response to the measles outbreak in his home town.

He told folks DON’T PANIC!!!!

More Measles Hysteria From Bob Sears

That was nearly four years ago, during the Disneyland measles outbreak.

So what’s he saying now?

From panic to hysteria - Dr. Bob on the measles outbreaks.

He’s moved from panic (a sudden overpowering fright) to hysteria (behavior exhibiting overwhelming or unmanageable fear or emotional excess), but is still pushing his usual talking points.

He has changed the way he is talking about measles deaths though.

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

Remember how he used to say that measles wasn’t deadly and that no one had died of measles in a long time? Now, instead of acknowledging that a woman got caught up in the 2015 outbreaks in Washington and died, he has shifted to saying that there hasn’t been a pediatric death in a long time.

Either way, it is important to understand something he leaves out. There are few deaths from measles these days because most folks are vaccinated!

When did Dr. Bob’s book about vaccines come out? The one with the alternative vaccine schedule?

Whatever his motivation, let’s take a look at what Dr. Bob is saying about measles…

“Measles hysteria is everywhere. And it’s clear the hysteria is a result of media fear around this disease, a disease every child used to get (and handle virtually without complication) not that long ago.”

Dr. Bob Sears

Not that long ago?

I’ve been a pediatrician for 22 years and I have never seen a child with measles. Neither did I have measles, as I was fortunate enough to grow up in the post-vaccine era for measles – a vaccine that has been available for since the 1960s.

And while every child did indeed once get measles, in the pre-vaccine era, not all handled it without complications, which is why measles was called the harmless killer.

Anti-vaccine folks try to hide the risks of measles in mortality rates, but the reality of it is that about 500 people died each year up until the early 1960s when the first measles vaccine was developed.

And I guess that wasn’t that long ago, after all, we had good hygiene and sanitation and healthcare at the time, and yet, a lot of people still died.

“There is another side to this measles conversation: how we’ve unintentionally shifted the burden of disease to babies and adults, both groups who are more likely to experience complications, by vaccinating all schoolchildren and losing natural immunity.”

Dr. Bob Sears

There is really only one side to this.

Folks who are intentionally not vaccinating their kids are getting measles and other vaccine-preventable diseases and are putting us all at risk to get sick.

After all, the MMR vaccine provides life-long immunity to most people. That’s not the problem.

If we went back to the pre-vaccine era, when everyone got measles naturally, as Dr. Bob seems to be advocating for, not only would those kids have to earn their immunity, but many babies (those who hadn’t had measles yet) and adults (those with immune system problems) would still be at great risk.

Are you starting to see how silly his arguments are?

We almost had measles beat!

Consider that there were just 37 measles cases in the United States in 2004. And that we have already had more than twice that amount this month alone!

And while measles was cyclical in the pre-vaccine era, it shouldn’t be when folks are vaccinated and protected. What happened to the cycles between 1997 and 2007?

“Unlike natural immunity, the measles vaccine does NOT offer lifelong protection. Estimates of its protection average around 15 years, and describe a phenomenon in the vaccine world known as “waning immunity.”

Melissa Floyd

The measles vaccine provides lifelong protection. Waning immunity only refers to protection against mumps. And no, there is no call for a third MMR dose for extra protection against measles.

“The other trend we’ve seen over the past 10 years is an increase in adult measles cases. “

Melissa Floyd

Dr. Bob’s sidekick neglects to mention that in addition to unvaccinated kis with measles, the trend is an increase in measles cases in unvaccinated adults! After all, most folks who get measles in these outbreaks are unvaccinated.

“To recap: by losing natural immunity for measles for children 5-19 years old, we’ve exposed babies, pregnant women, and adults to measles—all vulnerable groups who are more likely to experience serious complications from the disease.”

Melissa Floyd

Perhaps the only true statement that they make – “we’ve exposed babies, pregnant women, and adults to measles—all vulnerable groups who are more likely to experience serious complications from the disease.”

And no, vitamin A is not a proven therapy or measles in developed countries. It mainly helps prevent complications in kids who have a vitamin A deficiency.

Hopefully, it is becoming evident that what we need to stop is the anti-vaccine propaganda that keeps folks from vaccinating and protecting their kids. We need to stop the outbreaks.

More on More Measles Hysteria From Bob Sears

Did Better Hygiene and Sanitation Get Rid of Vaccine-Preventable Diseases?

Anti-vaccine folks, in addition to trying to argue that vaccines are full of poison, typically try to make a case that vaccines aren’t even necessary.

Why not?

They had good hygiene and sanitation in Brooklyn when my uncle got polio in 1950. What they didn't yet have was a polio vaccine.
They had good hygiene and sanitation in Brooklyn when my uncle got polio in 1950. What they didn’t yet have was a polio vaccine. If the wide use of indoor plumbing got rid of the plague in the early 1900s, why didn’t it get rid of all other infectious diseases at the same time?

Because, they claim, vaccines don’t even work. They claim that it was better hygiene and sanitation, not vaccines that helped get rid of smallpox, polio, and measles.

Did Better Hygiene and Sanitation Get Rid of Vaccine-Preventable Diseases?

On the surface, the idea that better hygiene and sanitation helped get rid disease makes a lot of sense.

“The 19th century shift in population from country to city that accompanied industrialization and immigration led to overcrowding in poor housing served by inadequate or nonexistent public water supplies and waste-disposal systems. These conditions resulted in repeated outbreaks of cholera, dysentery, TB, typhoid fever, influenza, yellow fever, and malaria.

By 1900, however, the incidence of many of these diseases had begun to decline because of public health improvements, implementation of which continued into the 20th century. Local, state, and federal efforts to improve sanitation and hygiene reinforced the concept of collective “public health” action (e.g., to prevent infection by providing clean drinking water).”

Achievements in Public Health, 1900-1999: Control of Infectious Diseases

It makes a lot of sense because better hygiene and sanitation did actually help control and eliminate many infectious diseases, including cholera, dysentery, and typhoid fever.

Others, like yellow fever and malaria, decreased because the mosquitoes that spread them were brought under control.

“Strategic vaccination campaigns have virtually eliminated diseases that previously were common in the United States, including diphtheria, tetanus, poliomyelitis, smallpox, measles, mumps, rubella, and Haemophilus influenzae type b meningitis.”

Achievements in Public Health, 1900-1999: Control of Infectious Diseases

That still left a lot of work for vaccines.

After all, we had good hygiene and sanitation in the United States when kids were routinely dying of polio, measles, Hib meningitis, pneumococcal meningitis, and rotavirus, etc.

Any way, if better hygiene and sanitation can get rid of so many diseases, why has each vaccine-preventable disease been controlled at a different time – yellow fever (1905), polio (1979), smallpox (1980), measles (2000), neonatal tetanus (2000), congenital rubella syndrome (2004), respiratory diphtheria (2009)?

What about the infectious diseases which don’t have vaccines? Why hasn’t better hygiene and sanitation helped control those diseases yet, like RSV, norovirus, Ebola, and Zika, etc.?

“Perhaps the best evidence that vaccines, and not hygiene and nutrition, are responsible for the sharp drop in disease and death rates is chickenpox. If hygiene and nutrition alone were enough to prevent infectious diseases, chickenpox rates would have dropped long before the introduction of the varicella vaccine, which was not available until the mid-1990s. Instead, the number of chickenpox cases in the United States in the early 1990s, before the vaccine was introduced in 1995, was about four million a year. By 2004, the disease incidence had dropped by about 85%.”

Misconceptions about Vaccines

And why does better hygiene and sanitation only work for chicken pox in countries that routinely use the chicken pox vaccine?

Do you want to believe that vaccines don’t work to justify skipping or delaying your child’s vaccines and leaving them unvaccinated and unprotected?

Be more skeptical, learn more about vaccines, and make the right choice to get your kids vaccinated.

More on the Hygiene and Sanitation Anti-Vaccine Theory

Why Are the DPT and OPV Vaccines Still Used in Some Countries?

As most folks know, neither the DPT nor OPV vaccines are used in the United States.

Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.
Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.

That they are still used in other countries likely raises some questions for those folks that get them.

Why Are the DPT and OPV Vaccines Still Used in Some Countries?

As I am sure you have guessed, there is no conspiracy about the continued use of these vaccines in other parts of the world. We aren’t getting rid of old stocks of vaccines or using cheaper vaccines in poorer parts of the world.

So what’s the reason?

To understand why they are still used in other countries, it helps to understand why they aren’t used here.

Remember that the DPT vaccine, which protects folks against diphtheria, pertussis, and tetanus, came under attack in the 1970s and 80s as some folks blamed the vaccine for causing vaccine injuries, including seizures and encephalopathy. It didn’t, but we still got a new vaccine, DTaP, which doesn’t seem to work as well.

“Although concerns about possible adverse events following their administration have led to the adoption of acellular pertussis vaccines in some countries, whole-cell pertussis vaccines are still widely produced and used globally in both developed and developing countries. Whole-cell pertussis vaccines that comply with WHO requirements, administered according to an optimal schedule have a long and successful record in the control of whooping cough. Furthermore, the excellent efficacy of some currently available whole-cell pertussis vaccine has also been shown, not only in recent clinical trials, but also on the basis of the resurgence of disease where vaccination has been interrupted or when coverage has markedly decreased. Therefore, WHO continues to recommend whole-cell pertussis vaccines for use in national immunization programmes.”

WHO on Recommendations for whole-cell pertussis vaccine

The WHO now recommends that if countries do switch to DTaP,  the acellular pertussis vaccine, they should be prepared to add additional periodic booster doses and immunizations during pregnancy, which may still “may not be sufficient to prevent resurgence of pertussis.”

The OPV vaccine, on the other hand, was replaced because it can rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polio virus (cVDPV). Of course, it does it at much lower rates than wild polio virus, so until polio is well controlled, the benefit of using OPV outweighs the risk. In addition to being less expensive and easier to use, OPV has the benefit over IPV of providing better herd immunity.

At some point, as we did in the United States in 2000, countries make a switch to the IPV vaccine.

In 2016, remaining countries that use OPV switched from trivalent OPV to bivalent OPV, because wild polio virus type 2 was eradicated in 1999. Once the remaining two types are eradicated, we can stop using the OPV vaccine altogether.

Until then, countries either use:

  • OPV plus one dose of IPV
  • sequential IPV-OPV schedules – high vaccine coverage and low risk of wild polio importation
  • IPV only schedules – sustained high vaccine coverage and very low risk of wild polio importation

So there is no conspiracy. These vaccines are safe and they work.

Without them, there would be over:

  • 1.3 million pertussis related deaths each year
  • 600,000 cases of paralytic polio each year

With most of these cases affecting young children.

More on the Continued Use of DPT and OPV Vaccines

Fake News About Measles Outbreaks?

Many news organizations ran with a story about a multi-state measles outbreak recently.

The CDC tweeted a correction about the multi-state measles outbreak story.
The CDC tweeted a correction about the multi-state measles outbreak story.

They got something wrong though.

There is no ongoing, single, multi-state outbreak of measles this year.

Fake News About Measles Outbreaks?

Is it understandable that some media outlets would have been confused by recent CDC reports?

Not really.

The CDC Measles Cases and Outbreaks page hadn’t been updated since late-July and is still reporting case numbers that are “current as of July 14, 2018,” so there really was no recent CDC report to generate all of this extra attention.

“From January 1 to July 14, 2018, 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia were reported to have measles.”

CDC on Measles Cases and Outbreaks

Although it has been changed to say “107 individual cases of measles have been confirmed in 21 states,” there was nothing to indicate it was a single outbreak that the CDC was monitoring as many sites reported:

Few sites were immune to using a click-bait title to scare folks about the "outbreak."
Few sites were immune to using a click-bait title to scare folks about the “outbreak.”

Unfortunately, many of these reports are still online.

How did it happen?

It’s likely because you have reports from organizations and websites that seem to want to push out content, but don’t have much of a budget to pay health or medical writers to make sure it is accurate.

2018 Measles Cases and Outbreaks

It’s also unfortunate that some of these sites, in trying to correct the idea of a single, nation-wide outbreak, are now trying to minimize this year’s measles outbreaks.

No, there isn’t one large outbreak that is spreading across the United States, but there are a lot of smaller outbreaks, some of which are still ongoing.

And these outbreaks are not something that should still be expected, as we have had a safe and effective measles vaccine for over 50 years and measles was declared eliminated in the United States in 2000!

There is also something very much different about 2018, that not surprisingly, no one is reporting about.

With over 107 cases, things seem very similar to last year right, when we had about 118 cases?

The thing is, in 2017, there was one large outbreak, in Minnesota, with 79 people.

In 2015, at least 139 of 189 cases were from just three large outbreaks, in California (Disneyland), Illinois, and South Dakota.

See what’s different?

This year seems to have more individual cases in more states, each with the potential to grow into one of those big outbreaks.

Why?

You can blame the rise in measles outbreaks in Europe and other parts of the world. And some folks not getting vaccinated and protected and exposing the rest of us when they get sick.

Putting us at risk even though measles is a life-threatening infection, a safe and effective vaccine has been available for 50 years, and every anti-vaccine myth that scares folks has been refuted a thousand times.

That’s the story.

Who’s telling it?

More on Reporting on Measles Outbreaks

Eradicated Diseases

Once a vaccine-preventable disease is eradicated, the worldwide incidence of the disease is reduced to zero so that intervention, including immunizations, are no longer needed.

Eradicated Diseases

Only one vaccine-preventable disease has actually been declared eradicated in the world – smallpox in 1980.

Rinderpest was also eradicated with vaccines, but unlike smallpox,  rinderpest was a disease of livestock.

The second vaccine-preventable disease to be eradicated will likely be polio.

Guinea worm disease may be eradicated first, but not with the help of vaccines.

Eliminated Diseases

Many more vaccine-preventable diseases have been eliminated, especially in developed countries.

Similar to eradication, when a disease is eliminated, the incidence of disease is reduced to zero, but only in a particular geographic area. Unlike eradication, since the disease is still around in other areas, people must continue to get vaccinated so that the disease doesn’t come back in that area.

To be more clear, when an epidemiologist says that a disease is eliminated in an area, what they are really saying is that the endemic form of the disease has been eliminated – someone has to reintroduce the disease from outside the area for outbreaks to occur. So you can still have cases and even big outbreaks, like we continue to see with measles in the United States, however, they always start with someone who initially got infected from outside the country.

In the United States, endemic yellow fever, polio, measles, rubella and respiratory diphtheria have all been eliminated. So have neonatal tetanus and congenital rubella syndrome:

  • endemic yellow fever (1905), spread by mosquito bites, was the first diseases to be eliminated
  • endemic polio was declared eliminated in 1979
  • endemic measles was declared eliminated in 2000
  • neonatal tetanus was declared eliminated before 2000
  • endemic rubella and congenital rubella syndrome were declared eliminated in 2004
  • endemic respiratory diphtheria was declared eliminated in 2009 and the last big outbreak was in the 1970s

Again, even though these diseases have been eliminated in the United States, that doesn’t mean that you can’t get them anymore. If you are not vaccinated or have a problem with your immune system and travel to an area of the world where these diseases are still common, you are at risk to get sick and bring that disease home with you, infecting others.

Disease Control

Unfortunately, not all diseases can be eliminated and eradicated.

This may have nothing to do with how well a vaccine works or whether or not people get their kids vaccinated though.

In some cases, an infection might not be contagious and is simply found in the environment, like Ascariasis (roundworms) or tetanus. To eradicate tetanus, we would have to get rid of the tetanus bacteria at its source – soil!

Other reasons that a disease might not be able to be easily eliminated or eradicated could include that:

  • it can also infect animals – rabies, yellow fever, Chagas’ disease
  • the disease causes infections without symptoms – Amebiasis
  • the presence of asymptomatic carriers – diphtheria
  • natural infection doesn’t provide life-long immunity – malaria
  • the disease doesn’t always have obvious symptoms – polio
  • people are contagious before they have obvious symptoms – measles

Hopefully these challenges will soon be overcome for more diseases though, especially vaccine-preventable diseases like polio and measles.

Goals for Global Elimination and Eradication of Diseases

Tragically, we have a long history of not meeting our goals for disease elimination and eradication.

Still, a lot of progress has been made over the years, millions of lives have been saved, and many more deaths will be prevented if we meet our current goals to eradicate or eliminate these diseases:

  • polio – since the initial war on polio was started by President Franklin D Roosevelt in 1938 and the development of the first polio vaccines in the 1950s to the creation of The Global Polio Eradication Initiative in 1988, eradicating polio has been a priority for health experts. Unfortunately, we missed the first goal of eradicating polio by 2000, but are certainly getting close, as only three countries still have endemic polio – Afghanistan, Nigeria and Pakistan – and worldwide cases are at all time lows. The new goal is to have a polio-free world by 2018!
  • measles – We have missed a lot of the goals on the way to eradicating measles, including the goal to eliminate measles in the United States by 1982 (wasn’t met until 2000), the goal of global eradication of measles by 2010 which was first set in 1996, and the goal of reducing global measles mortality by 90% by 2010 over 2000 levels (there was a 74% decrease though!). We will hopefully meet the latest goals of the Global Measles and Rubella Strategic Plan 2012-2020.
  • maternal and neonatal tetanus – while many people associate tetanus with stepping on a rusty nail, tetanus can also affect mothers and their newborn babies, especially when hygienic practices aren’t available when the baby is delivered or when they care for the baby’s umbilical cord. Although the target dates have been postponed from the initial goals of 1995, 2000, 2005 and 2015, eliminating maternal and neonatal tetanus is still a goal. Considering that at least 34,000 newborns died of neonatal tetanus as late as 2015, which is down from 787,000 in 1988, significant progress continues to be made by the Maternal and Neonatal Tetanus Elimination partnership.
  • Guinea worm disease – although not usually life-threatening, Guinea worm disease is still a serious disease that causes suffering for those who become infected with the Guinea worm larvae that can grow to become adults that are 2 to 3 feet long. Fortunately, Guinea worm disease should be the next disease that is eradicated, with cases at an all time low thanks to the efforts of The Carter Center.
  • lymphatic filariasis (Elephantiasis) – transmitted by infected mosquitoes, lymphatic filariasis is another disabling condition that has been targeted for elimination using insecticidal bed nets and drugs donated by Merck and GlaxoSmithKline, hopefully by 2020.
  • taeniasis/cysticercosis (tapeworms) – eating undercooked pork that is infected with larval cysts of the tapeworm Taenia solium can cause intestinal tapeworms (taeniasis). Swallowing the eggs of these intestinal tapeworms (located in an infected persons feces) can lead to getting cysticercosis, in which the larval cysts can infect brain (neurocysticercosis) and muscle tissue, etc. Although thought to be potentially eradicable, cysticercosis is considered to be of several major neglected tropical diseases.
  • mumps – a vaccine-preventable disease that is thought to be potentially eradicable.
  • leprosy – using expanded multi-drug therapy regimens, leprosy is now in the final push phase of elimination.
  • river blindness (onchocerciasis) – a parasitic infection that is spread through the bite of small black flies, river blindness is targeted for eliminated in select regions using a drug donated by Merck.
  • trachoma – another eye infection that is spread by flies and which can lead to blindness, blinding trachoma is targeted for global elimination by 2020. In addition to health education and corrective eye surgeries, the effort has been aided by Pfizer donating an antibiotic to fight trachoma.
  • rubella – rubella is also also targeted for elimination from at least five WHO regions by 2020.

Unfortunately, even as we make progress to control, eliminate, and eradicate these diseases, some are beginning to make a comeback.

And no, it is not just because of parents choosing to intentionally not vaccinate their children. In many parts of the world, in addition to the humanitarian crisis and health challenges posed by natural disasters, children are getting sick in war zones and refugee camps and simply can’t be vaccinated.

What to Know about Eradicated Diseases

Vaccines work well and have helped control, eliminate, and in the case of smallpox, eradicate diseases.

More on Eradicated Diseases