Do you remember when we used to have rubella outbreaks in the United States?
Yeah, me neither, but in the rubella epidemics of the 1960s, rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome.
Japan’s Rubella Outbreak
Thanks to the rubella vaccine, the ‘R’ in the MMR, we rarely hear about rubella anymore.
There are still relatively few cases, but most of us would like to keep it that way.
We remember that with the return of measles in the late 1980s, rubella came back right along with it, causing 13 deaths and 77 cases of congenital rubella syndrome!
And that’s what is happening in many countries right now.
In Japan, for example, in addition to a rise in measles cases this year, they are seeing big outbreaks of rubella, with weekly totals exceeding 100 cases! These are numbers that are close to what they saw during outbreaks in 2013, a year that ended with 14,344 cases of rubella and 32 cases of congenital rubella syndrome.
Japan is on track to have a big rubella year.
And they are already reporting at least one case of congenital rubella syndrome, a 4 week old, which is not surprising, considering that they had nearly 3,000 cases of rubella last year.
A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.
Is that what we want to happen here too? Are folks looking forward to having to worry about babies being born with congenital rubella syndrome, a vaccine-preventable disease?
While you likely aren’t too surprised about the flu deaths and the cases of meningococcal disease, did you know that kids still get Hib, babies still get hepatitis B, and that there were three cases of human rabies and a case of diphtheria in the United States last year?
When Was the Last Case of Diphtheria?
Yes, diphtheria.
That’s despite the fact that the diphtheria vaccine has been around for over 100 years, long before it was combined with the first whole cell pertussis vaccine and the tetanus vaccine to form the DPT vaccine.
A vaccine that helped control respiratory diphtheria, which could lead to the formation of a pseudomembrane in a child’s airway, giving diphtheria the nickname of the “strangling angel.”
The last big outbreaks of diphtheria in the United States occurred in the 1970s, although sporadic cases had continued since, albeit at lower and lower levels each year. Eventually, endemic respiratory diphtheria was declared eliminated in 2009.
Still, we know that there have been some recent cases of diphtheria in the United States.
In April of 2014, a teen from Montgomery County, Ohio developed diphtheria.
And again in April of 2018, someone in Oklahoma developed diphtheria.
Why do we care about a few isolated cases?
Because we know how quickly diphtheria can come back if we stop vaccinating our kids!
Just look at what is happening in many other countries that once had these diseases under good control:
a 22-year-old unvaccinated women who died in Australia (2011)
an unvaccinated 3-year-old who died in Belgium (2016)
a family that became infected in South Africa in which at least one child died (August 2017)
Sandra Roush and Trudy Murphy provided us with pre-vaccine baselines for 13 vaccine-preventable diseases in their article, Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.
“A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”
Roush et al on Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.
Their study, which came out in 2007, used morbidity (2006) and mortality (2004) data that was recent at the time. The data has held up very well since then, looking at 2018 statistics in the National Notifiable Infectious Diseases Weekly Tables (see below), even with talk of waning immunity for some vaccines.
“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”
Walter Orenstein, MD
The pre-vaccine era for Hib was just before 1988, when the first Hib vaccine came out. We had good hygiene, sanitation, and nutrition in the 1980s and yet, a lot of kids died from Hib meningitis and epiglottitis. At least they did until he got a vaccine to prevent it.
And if it was better hygiene and sanitation, etc., why did it affect every disease at a different time? And why hasn’t better hygiene and sanitation stopped RSV, HIV, norovirus, Zika, and all of the other non-vaccine-preventable diseases?
Vaccines aren’t perfect, but they are safe, with few risks, and work well. Get vaccinated and protected if you want to keep from getting and bringing back these now vaccine-preventable diseases.
Dr. Bob Sears, who actually wrote a book about vaccines, seems to think that he and his podcasting sidekick have put the nail in the coffin “of trying to use the herd immunity argument to justify coerced vaccinated.”
Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument
While arguing against the idea of herd immunity and for coerced vaccination are common among anti-vaccine folks, neither is true.
Herd immunity is real and no-one is going to force anyone to vaccinate their kids. Vaccine mandates do not mean forced vaccination.
What about the idea that “all vaccines wane within about 2-15 years, leaving vaccinated children & adults unprotected?”
If that were true, then wouldn’t everyone who got sick in latest outbreaks be vaccinated? Why are most folks unvaccinated?
So we are either getting a lot of outbreaks because of waning immunity or your titers are getting boosted because you are getting exposed to so much natural disease. Got it?
While waning immunity is an issue for some vaccines, like mumps and pertussis, the primary and secondary failure rates are still not as bad as Dr. Bob suggests, which is why, in an outbreak, the attack rate of disease is always higher among those who are unvaccinated and unprotected.
The numbers don’t always add up correctly when anti-vax folks try to do math.
Is herd immunity the main argument that’s made when experts suggest we need stronger vaccine laws? I always thought the main argument is that folks should just vaccinate and protect their kids, but maintaining herd immunity so that your intentionally unvaccinated kids don’t put everyone else at risk is a good reason too.
Does everyone see the problem with Melissa Floyd’s math? This probably won’t be on the SAT, but you still want to get this right…
Like many others are doing right now, she used state level data. Since many of the folks who don’t vaccinate their kids cluster together in the same communities and schools, the “2% of those filing for exemptions” end up making up 10, 20, or even 30% of some school’s student population.
“This means if you are a primary non-responder, you are walking around every day with a false sense of security, clinically unvaccinated for that particular disease.”
Because vaccines aren’t 100% effective, we can walk around all day without actually thinking about it much, hoping that we can rely on the fact that most other people are also vaccinated and protected. That keeps disease out of our community or herd.
The system typically breaks down though, not because vaccines aren’t effective enough, but because too many folks don’t get vaccinated.
“A 2011 article in “Vaccines”, edited by Stanley Plotkin, says, “Much of the early theoretical work on herd immunity assumed that vaccines induced solid immunity against infection…” Theoretical… Assumed…”
Melissa Floyd
She should have read the whole article, or at least used the whole quote…
“Much of the early theoretical work on herd immunity assumed that vaccines induce solid immunity against infection and that populations mix at random, consistent with the simple herd immunity threshold for random vaccination of Vc = (1-1/R0), using the symbol Vc for the critical minimum proportion to be vaccinated (assuming 100% vaccine effectiveness). More recent research has addressed the complexities of imperfect immunity, heterogeneous populations, nonrandom vaccination, and freeloaders.”
“What’s funny is after the measles vaccine was licensed in 1963, the medical community declared a goal of eradicating measles by 1967. But 1967 came and went and it still wasn’t gone, 1977, 1987, 2000… the dates kept getting pushed, and the result was always the same. Meanwhile they continued to increase the hypothesized “herd immunity threshold”, eventually winding up at the extremely high 95% you hear today. “
What happened to the previous goals of eliminating measles?
“In 1966, the USA began an effort to eradicate the disease within its own borders. After a series of successes and setbacks, in 2000, 34 years after the initial goal was announced, measles was declared no longer to be endemic in the USA.”
Orenstein et al on Eradicating measles: a feasible goal?
Along the way, we have gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.
“Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020.”
Measles
While there is doubt that we can truly eradicate measles with the current vaccine, we can certainly control and eliminate measles if folks stop listening to anti-vaccine propaganda and they get vaccinated and protected.
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.
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.
Yes, although anti-vaccine folks needlessly worry about shedding when kids get routine childhood vaccines and even talk about a shedding season, with the smallpox vaccine, problems with shedding are really a thing.
Since the smallpox vaccine is a live virus vaccine and since it very commonly causes a skin reaction at the injection site, shedding can spread it to others. While that’s a good thing with some vaccines, like the oral polio vaccine, because it increases herd immunity, it isn’t with the smallpox vaccine.
If the weakened smallpox vaccine can cause a skin reaction on your arm where you got the shot, what is it going to do if it gets on a child’s skin that is irritated all over with eczema?
An 8-month-old boy with eczema vaccinatum. Photo by CDC/Arthur E. Kaye
It’s a good thing that we don’t routinely have to use the smallpox vaccine anymore.
“Because persons with eczema are deferred from vaccination, only a single, accidentally transmitted case of EV has been described in the medical literature since military vaccination was resumed in the United States in 2002.”
Everything You Need to Know About the Measles Vaccine
So why are some parents still afraid to allow their kids to get vaccinated and protected, putting them at risk to get measles, a life-threatening disease?
“Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication and in order to reduce morbidity and mortality associated with mumps and rubella.”
Cochrane Systematic Review on Vaccines for measles, mumps and rubella in children
Let’s see if you still are after we get all of your questions about the measles vaccine answered…
Schools in California were closed for at least two weeks in 1917 because of measles epidemics.
How long has the measles vaccine been around? The very first measles vaccine was licensed by John Enders in 1963. An improved measles vaccine was developed by Maurice Hilleman and licensed in 1968, and that is the measles vaccine that we still use today, at least in the United States. It was combined into the MMR vaccine in 1971.
How effective is the measles vaccine? A single dose of the measles vaccine is about 93% effective at preventing a measles infection. Two doses (the second dose was added to the routine immunization schedule in 1994) are up to 97% effective. That’s why almost all of the people who get measles in an outbreak are unvaccinated.
How long does immunity from the measles vaccine last? Immunity from the measles vaccine is thought to be life-long. It is important to understand that the second dose isn’t a booster dose, but is instead for those few folks who don’t respond to the first dose.
Who should get the measles vaccine? Everyone without a true medical contraindication should get the measles vaccine (MMR), with the first dose at 12-15 months and a second dose at 4-6 years.
Can my kids get their measles vaccine early? An advanced immunization schedule is available for kids in an outbreak or if they will be traveling out of the country. The first dose can be given as early as age 6-months, but is repeated when the child is 12 months because of concerns of interference with maternal antibodies. The official second dose can be given early too, as early as 4 weeks after the first dose, as long as the child is at least 12 months old.
Do I need a booster dose of the measles vaccine? People who are fully immunized do not need a booster dose of the MMR vaccine, but it is important to understand whether or not you are really fully immunized to see if you need a second dose. Some adults who are not high risk are considered fully vaccinated with only one dose, while others should have two doses. Are you at high risk to get measles? Do you travel, live in an area where there are measles outbreaks, go to college, or work as a health care professional?
Should I check my measles titers? In general, it is not necessary to check your titers for measles. If you haven’t had two doses of the MMR vaccine, then get a second dose. If you have had two doses of the MMR vaccine, then you are considered protected. Keep in mind that there is no recommendation to get a third dose of MMR for measles protection, although it is sometimes recommended for mumps protection during a mumps outbreak.
If my child gets a rash after getting his MMR, does that mean that he has measles? No. This is a common, very mild vaccine reaction and not a sign of measles.
Can the measles vaccine cause seizures? The MMR vaccine can cause febrile seizures. It is important to remember that without other risk factors, kids who develop febrile seizures after a vaccine are at the same small risk for developing epilepsy as other kids. And know that vaccines aren’t the only cause of febrile seizures. Vaccine-preventable diseases can cause both febrile seizures and more serious non-febrile seizures.
Why do people think that that the measles vaccine is associated with autism? It is well known that this idea originated with Andrew Wakefield, but the real question should be why do some people still think that vaccines are associated with autism after so much evidence has said that they aren’t?
What are the risks of the measles vaccine? Like other vaccines, the MMR vaccine has mild risks or side effects, including fever, rash, and soreness at the injection site. Some more moderate reactions that can rarely occur include febrile seizures, joint pain, and a temporary low platelet count. More serious reactions are even rarer, but can include deafness, long-term seizures, coma, or lowered consciousness, brain damage, and life-threatening allergic reactions.
Why are there so many reports of measles vaccine deaths? There are extremely few deaths after vaccines. The reports of measles vaccine deaths you see on the Internet are just reports to VAERS and are not actually reports that have been proven to be caused by a vaccine. As with other vaccines, the risks from having a vaccine-preventable disease are much greater than the risks of the vaccine. The only reason that it might not seem like that now is because far fewer people get measles now than they did in the pre-vaccine era, when about 500 people died with measles each year.
When did they take mercury out of the measles vaccine? Measles vaccines, including the MMR, have never, ever contained mercury or thimerosal.
Why do we still have outbreaks if we have had a measles vaccine since 1963? In the United States, although the endemic spread of measles was declared eliminated in 2000, many cases are still imported from other countries. As measles cases increase around the world, that is translating to an increase in outbreaks here. Even though overall vaccination rates are good, because there are many pockets of susceptible people in areas that don’t vaccinate their kids, they get hit with outbreaks.
Can we eradicate measles? Because measles is so contagious, the vaccine does have failures, and some folks still don’t get vaccinated, there is some doubt that we can eradicate measles without a better vaccine. That doesn’t mean that the current measles vaccines can’t prevent outbreaks though…
Are you ready to get your kids their MMR vaccine so that they are vaccinated and protected against measles, mumps, and rubella?
