Tag: eradicated diseases

What’s Your Chance of Getting Measles Right Now?

It shouldn’t be a surprise that a lot of folks are thinking about their risk of getting measles right now.

But with record levels of measles cases this year, some of us are thinking about our level of risk much differently than others.

rIf you are unvaccinated and exposed to someone with measles, you risk is actually 1,000,000 times higher…

While most of us simply want to make sure we are vaccinated and protected, anti-vaccine folks are taking every opportunity to downplay their risks.

What’s Your Chance of Getting Measles Right Now?

So what’s your chance of getting measles?

“Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.”
WHO on Measles

That’s actually not that simple to figure out, but depends on:

Whether or not you are vaccinated and protected, with two doses of the MMR vaccine, and immune to measles.
Your plans to travel out of the country.
How often you are around people who routinely travel out of the country.
How many of your friends and family members are intentionally unvaccinated.

Those who have had two doses, with no plans to travel, and who live in an area with no reported cases, are at extremely low risk to get measles – the risk won’t be zero until measles is eradicated.

In this kind of low risk situation, kids don’t need early doses of MMR vaccines and most adults can probably get away with just having one dose of MMR.

“Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, 9 out of 10 people of all ages around him or her will also become infected if they are not protected.”
CDC on Measles is Highly Contagious

On the other hand, if you are unvaccinated and were at the AMC Theater on Lemon Street in Fullerton, between 11 p.m. and 4 a.m. on April 25, then your chance of getting measles is about 90%!

Wait! That’s a little more than the 0.000092% chance that anti-vaccine folks are throwing around…

The odds of being hit by lightning are low because we practice storm safety and don’t run around outside when we see lightning!

To think of it another way, if you knew that your chances of getting hit by lightning were a little over 1 in a million, would that make you think it is okay to go outside and play golf during a severe thunderstorm?

Would you think the risk is so low that you could let your kids play outside if you heard thunder and saw lightning flashes nearby, or would you all rush inside?

That’s right! The risk of getting hit by lightning is low because most of us don’t take chances when we hear thunder or see lightning.

It’s the same with measles and other vaccine-preventable diseases.

The overall risk is low because most people are vaccinated and protected!

If you aren’t vaccinated and protected, as we see more and more cases, your risk of getting sick, and getting others sick, is going to continue to get higher and will always be much higher than someone who is fully vaccinated, no matter how much you want to believe in shedding, mild measles, or whatever myths help you justify keeping your kids unvaccinated and unprotected during an outbreak.

Remember, you can’t hide in the herd if you are scaring away too much the herd…

Vaccines are safe, with few risks, and are obviously necessary.

You can avoid getting measles. — You can greatly reduce your family’s risk of getting measles.

Make sure your family is protected so they don’t get caught up in a measles outbreak

Alexander Langmuir on Measles

It’s a shame that most people only know of Alexander Langmuir because anti-vaccine folks like to make it sound like he was against vaccines.

How do they do that?

By making up quotes and using some real quotes out of context.

Alexander Langmuir on Measles

Remember the Alexander Langmuir quotes about flu vaccines?

He never really said that “no one should take the flu vaccine.”

And now folks are misrepresenting what he said about measles.

Alexander Langmuir was a big advocate of the measles vaccine.

So what did he really say?

“This self-limiting infection of short duration, moderate severity, and low fatality has maintained a remarkably stable biological balance over the centuries. Those epidemiologists, and there are many, who tend to revere the biological balance have long argued that the ecological equilibrium of measles is solidly based, that it can not readily be disrupted and that therefore we must learn to live with this parasite rather than hope to eradicate it. This speaker, not so long ago, was counted among this group and waxed eloquent on this subject in print.
Happily, this era is ending. New and potent tools that promise effective control of measles are at hand. If properly developed and wisely used, it should be possible to disrupt the biological balance of measles. Its eradication from large continental landmasses such as North America and many other parts of the world can be anticipated soon.”
Alexander Langmuir et al on The Importance of Measles as a Health Problem

Alexander Langmuir didn’t think that measles was a benign disease.

“…any parent who has seen his small child suffer even for a few days with persistent fever of 105, with hacking cough and delirium wants to see this prevented…”
Alexander Langmuir

And he thought that we should work to eradicate it.

“The availability of potent and effective measles vaccines, which have been tested extensively of the past 4 years, provides the basis for the eradication of measles in any community that will raise its immune thresholds to readily attainable levels.”

Alexander Langmuir et al on Epidemiologic Basis For Eradication Of Measles In 1967

Alexender Langmuir, who was Chief Epidemiologist at CDC for 21 years and founded the Epidemic Intelligence Service (EIS), said that “all infants should receive measles vaccine at approximately 1 year of age.”

What else did he say?

“When measles has become so widespread that epidemics are already present in several schools and in different communities within a city or county, more extensive communitywide measures must be undertaken. Then the full resources of the health and medical services of the total community, backed by well-coordinated voluntary agencies, will need to be mobilized. Again, priority should be directed first to the immunization of susceptible children in schools or who congregate in other enclosed spaces. If such immunization programs are carried out promptly and effectively, an epidemic of measles can be contained within 2 to 3 weeks.”
Alexander Langmuir

It would be nice to get back to where we could contain outbreaks in 2 to 3 weeks.

It would be nice if folks really listened to what Alexander Langmuir had to say and vaccinated their kids.

Why Do We Include SSPE When Counting Measles Deaths?

Anti-vaccine folks often like to push the idea that parents shouldn’t worry about measles and that it is just a rash with a little fever.

They leave out the part that it is a week of having a high fever, irritability, and other symptoms too.

In addition to downplaying the symptoms of measles, they never talk about the possible complications, such as encephalitis, seizures, and death.

Why Do We Include SSPE When Counting Measles Deaths?

They certainly never talk about SSPE or subacute sclerosing panencephalitis.

“Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus.”
Subacute Sclerosing Panencephalitis Information Page

SSPE is a late complication of having a natural measles infection.

That’s why it should be included when counting measles deaths.

“Available epidemiological data, in line with virus genotyping data, do not suggest that measles vaccine virus can cause SSPE. Furthermore, epidemiological data do not suggest that the administration of measles vaccine can accelerate the course of SSPE or trigger SSPE in an individual who would have developed the disease at a later time without immunization. Neither can the vaccine lead to the development of SSPE where it would not otherwise have occurred in a person who has already a benign persistent wild measles infection at the time of vaccination.”
Subacute sclerosing panencephalitis and measles vaccination

It is not a complication of having a measles containing vaccine. If it were, then why didn’t we see more cases of SSPE as more and more people got vaccinated, instead of a drop in SSPE cases and deaths, corresponding to a drop in measles cases?

But SSPE isn’t gone yet, just like measles hasn’t yet been eradicated.

32 of these SSPE deaths have been since 2000. Source is the CDC Wonder database.

Since 2000, when the endemic spread of measles was eliminated in the United States, there have been at least 37 SSPE deaths.

“Investigators learned that, in 2012, at age 11 years, the boy, who was previously healthy and developmentally normal, had been admitted to a tertiary care children’s hospital in Oregon with severe, progressive encephalopathy. Before the onset of his neurologic illness, the patient had been a straight-A, fifth-grade student who played soccer and basketball. The symptoms began approximately 4 months before the hospital admission, when the patient began to struggle with homework, drop utensils, and doze off during meals, eventually progressing to falling asleep while walking.”
Notes from the Field: Subacute Sclerosing Panencephalitis Death — Oregon, 2015

I say at least, because the CDC Wonder database doesn’t list the 2015 SSPE death of a boy in Oregon.

Anti-vaccine folks like to ignore the fact that yes, people have died of measles recently. And measles puts you at risk for SSPE, which is always fatal.

We are fortunate that no one has died since 2015, but as we get more and more measles cases, tragically, in addition of the risk of someone dying of measles directly, it increases the risk that someone will eventually develop SSPE.

“Decreasing rates of vaccination in the United States, particularly among preschool-aged children (children <5 years of age) living in inner-city areas, resulted in a resurgence in the number of cases of measles reported during 1989–1991; during this period, 55,622 cases of measles and 123 measles-associated deaths were reported.”
Bellini et al on Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized

Remember, there were at least 12 extra SSPE deaths following the large measles outbreaks of the late 1980s.

Will we see any after the rise in the cases the last few years?

Vaccines are safe, with few risks, and obviously necessary.

Don’t risk a complication of measles. Don’t risk getting SSPE.

Did CNN Rename Mumps?

It’s a common anti-vaccine myth that we rename diseases to make them go away. It helps them explain the control, elimination, and eradication of diseases, since many of them don’t believe that vaccines actually work.

Simply saying that your article is "Fact Checked" doesn't make it so... — Simply saying that your article is “Fact Checked” doesn’t make it so…

Now imagine that “they” actually found evidence that we did rename vaccine-preventable diseases!

That would be something, wouldn’t it…

Did CNN Rename Mumps?

Of course, they haven’t.

The original CNN story about the USS Fort McHenry stated that the sailors and Marines had parotitis, which was “due to an outbreak of a viral infection similar to mumps.”

Why didn’t they just say that they had mumps?

Because that’s not what they were told by the US Navy’s Fifth Fleet.

“… a military medical team specializing in preventative medical care is expected to deploy in the coming days to make an assessment if further steps may be needed, according to the official.”
US warship quarantined at sea due to virus outbreak

It may come as a surprise to some people, but many viruses and bacteria can cause parotitis. And until the outbreak was further investigated, they didn’t know if it really was mumps or another condition.

Since then, the Navy’s Bureau of Medicine and Surgery (BUMED) has stated that “based on clinical presentation and laboratory testing, these cases are currently classified as probable cases of mumps.”

Still, a very small percentage of the sailors and Marines on board have gotten mumps. That’s because vaccines work, even when they don’t work perfectly well.

Japan’s Rubella Outbreak Should Be a Warning About What Could Happen Here

Do you remember when we used to have rubella outbreaks in the United States?

There is a level 2 travel alert for Japan because of outbreaks of rubella.

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.

Tragically, like measles and other vaccine-preventable diseases, rubella is coming back.

	Rubella	Congenital Rubella Syndrome
2013	9	1
2014	6	1
2015	5	1
2016	1	2
2017	7	5
2018	5
2019	2

There are still relatively few cases, but most of us would like to keep it that way.

The US had a big spike in rubella cases in the last 1980s.

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?

A vaccine-preventable disease that was declared eliminated in the United States in 2004.

When Was the Last Case of Diphtheria?

Believe it or not, measles isn’t the only vaccine-preventable disease that is still around.

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.

Diphtheria strikes unprotected children.

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)
at least 7 cases of diphtheria in Ukraine (2018)
an unvaccinated man in Australia who died (2018)
a case in Canada (2018)
8 cases and 3 deaths in Columbia (2018)

Not to mention the large number of diphtheria deaths in Yemen, Venezuela, Haiti, and among Rohingya refugees.

Let’s not bring these diseases back. Vaccines are safe, with few risks, and obviously necessary.

We Know Vaccines Work

We know vaccines work.

How well do they work?

In addition to eradicating smallpox, did you know that vaccines have helped eliminate four other now vaccine-preventable diseases?

diphtheria
neonatal tetanus
polio
congenital rubella syndrome

And unlike measles, which was declared eliminated in 2000, we really don’t see these diseases anymore.

We Know Vaccines Work

How well do vaccines work?

Let’s look at the disease counts (morbidity data), how many kids got sick, just before we developed a vaccine and where we are now:

Disease	Pre-Vax Era	Now	% Decrease
Smallpox	110,672	last case 1977	100%
Diphtheria	30,508	1	99.9%
Pertussis	265,269	13,439	94.9%
Tetanus	601	20	96.7%
Neonatal Tetanus	1,000+	0	100%
Polio	21,269	last case 1993	100%
Measles	763,094	372	99.9%
Mumps	212,934	2,251	98.9%
Rubella	488,796	5	99.9%
Congenital Rubella Syndrome	20,000	0	100%
Hib invasive	18,000	27	99.9%
HepB	300,000	2,799	99.1%
Perinatal HepB	16,200	952	94.1%
Pneumococcal invasive	64,400	986	98.5%
HepA	254,518	11,166	95.6%
Varicella	5,358,595	6,892	99.9%

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.

But can’t you explain all of this decline away by talking about better hygiene, sanitation, and nutrition?

Of course not!

“…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?

Although there was a decline in mortality rates at the beginning of the 20th Century for all diseases thanks to better hygiene, sanitation, and nutrition, that effect plateaued by the mid-1930s. And since a lot of people were still getting sick, remember everyone used to get measles, even if a small percentage would die, it would add up to a lot of deaths!

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.

VAXOPEDIA

What’s Your Chance of Getting Measles Right Now?

What’s Your Chance of Getting Measles Right Now?

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