Can you explain why we will almost certainly have the second highest number of measles cases in one year since 1994, even though we see the devastation that high rates of measles is causing in Europe and other parts of the world?
How many people will get measles in the United States this year?
Although no one is reporting on this, with several large ongoing outbreaks still not under control – it will be another record year for measles in the United States.
And with several large outbreaks continuing overseas, next year doesn’t look like it will be much better, especially with reports of a measles resurgence in many regions of the world.
After a 4-month-old died of bacterial meningitis, anti-vaccine folks pushed the idea that it was a vaccine injury instead of an infection.
And they push their views that everything is a vaccine injury on everyone, even though most folks understand that vaccines are not associated with SIDS, shaken baby syndrome, autism, and most other things.
Sure, everyone and everything in anti-vaccine world is the very best, except if they are, then why are they trying so hard to convince you of that… So maybe you will agree with some of their more far-out claims, suggestions, and conspiracy theories?
Do you think it is okay to put infants who are too young to be vaccinated at risk for measles and other vaccine-preventable diseases because you don’t like the choices you have been given between getting your kids vaccinated and protected or keeping them out of school?
What about the parents of the kid who is being treated for cancer who gets exposed to chicken pox because someone else made the choice to not vaccinate their kid? Do you think that’s fair?
The modern anti-vaccine movement is only about choice when it is about their choices and doesn’t seem to care about the risks their unvaccinated kids pose to others.
Believe it or not, the modern anti-vaccine movement also equates getting vaccinated with rape…
Don’t believe me?
Do you agree?
What else do most folks in the modern anti-vaccine movement believe?
They believe that:
vaccines don’t work, but are somehow still able to cause shedding for long periods of time
News like that and folks getting exposed to other infectious diseases, probably has them wondering just how contagious these diseases are. Do you have to be sitting next to someone to get them? In the same row? On the same floor?
Understanding Your Risk of Catching a Disease
Fortunately, most diseases are not terribly contagious.
We worry about some things, like SARS and Ebola, because they are so deadly, not because they are so contagious or infectious.
Wait, contagious or infectious? Aren’t they the same thing?
To confuse matters, some infectious diseases aren’t contagious, like Lyme disease. And some vaccine-preventable diseases are neither infectious nor communicable. Think tetanus. You may have never thought of it that way, but you aren’t going to catch tetanus from another person. Of course, that’s not a good reason to skip getting a tetanus shot!
To understand your risk of getting sick, you want to understand a few terms, including:
infectious disease – a disease that can be transferred to a new host
communicable – an infectious disease that can be transferred from one host to another
non-communicable – a non-infectious disease which can not be transferred from one host to another
contagiousness – an infectious disease that is easily transferred from one person to another
infectivity – the ability of an infectious agent to cause an infection, measured as the proportion of persons exposed to an infectious agent who become infected. Although this doesn’t sound much different from contagiousness, it is. The Francisella tularensis bacteria is highly infectious, for example, to the point that folks exposed to a culture plate are given antibiotics or put on a fever watch. Few of us get tularemia though, because transmission is through tick bites, hunting or skinning infected rabbits, muskrats, prairie dogs and other rodents, or inhaling dust or aerosols contaminated with F. tularensis bacteria. So if you get exposed, you will probably get sick, but there is a low probability for getting exposed.
incubation period – the time it takes to start having symptoms after you are exposed to an infectious disease. A longer incubation period increases the chances that someone will get exposed to a disease and travel home before getting sick. A shorter incubation period, like for influenza, means that a lot of people can get sick in a short amount of time.
contagious period- the time during which you can spread the illness to other people and may start before you have any symptoms
quarantine – used to separate people who have been exposed to a contagious disease and may become sick, but aren’t sick yet
isolation – used to separate people who are already sick with a contagious disease
transmission – how the disease spreads, including direct (direct contact or droplet spread) vs indirect transmission (airborne, vehicleborne, or vectorborne)
R0 (r nought) – the basic reproductive number or the number of new infections originating from a single infectious person among a total susceptible population
Rn – the net reproductive number, which takes into account the number of susceptibles in a community
infectious period – how long you are contagious
Got all that?
How Contagious Is Measles?
If not, understanding how easily you can get measles should help you understand all of these terms.
Measles is highly contagious, with a very high R0 number of 12 to 18.
the measles virus can live for up to two hours on surfaces and in the airspace where an infected person coughed or sneezed
infected people are contagious for up to four days before they have a rash and even know that they have measles, so expose lots of people even if they get put in isolation once they get diagnosed
infected people continue to be contagious for up to four days after the rash appears, so can continue to expose people if they aren’t put in isolation
So you don’t need to have someone with measles coughing in your face to get sick. If they coughed or sneezed at the grocery store, on the bus, or at your doctor’s office and then you entered the same area within two hours, then you could be exposed to the measles virus and could get sick.
Yes. The minimum age for the first dose of rotavirus, DTaP, IPV, Hib, Prevnar, is 6 weeks.
Some other vaccines can be given earlier than their recommended age too, including:
the first MMR vaccine, which can be given as early as age 6 months in certain high risk situations, like traveling out of the country or in an outbreak situation, although this dose will have to be repeated once the child is 12 months old
the 4th dose of DTaP, which can be given as early as age 12 to 15 months, as long as at least 4 to 6 months have passed since the third dose
the 2nd dose of Varivax, which may be given as early as 1 to 3 months after the first dose
the Tdap vaccine, which can be given as early as age 7 years, instead of the more typical 11 to 12 years
the HPV vaccine, which can be given as early as age 9 years, instead of the more typical 11 to 12 years
Why would you get a vaccine early?
What if you are going to be traveling just before you infant is going to be 2 months old? Or your 9 year old stepped on a rusty nail, and it had been just over 5 years since his last tetanus (DTaP) shot?
Recommended and Minimum Intervals for Vaccines
In addition to earlier ages, you can sometimes get vaccines more quickly, on an accelerated schedule.
the minimum interval between the 1st and 2nd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
the minimum interval between the 2nd and 3rd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
the minimum interval between the 1st and 2nd dose of HPV is either 4 weeks (3 dose schedule) or 5 months (2 dose schedule)
the minimum interval between the 2nd and 3rd dose of HPV is 12 weeks
the minimum interval between the 1st and 3rd dose of HPV is 5 months, instead of the standard 6 months
Why give these vaccines more quickly than usual?
The usual reason is that a child is a little behind and is working to get caught up.
Absolute Minimum Ages for Vaccines
It is important to remember that in some cases, there are some hard and fast rules about minimum ages. That means that if you get these vaccines any earlier, they won’t count and you will likely have to repeat them, including getting :
the 3rd dose of hepatitis B before 6 months (24 weeks) or sooner than 8 weeks after 2nd dose and 16 weeks after 1st dose
the first dose of MMR, Varivax or hepatitis A before 12 months
the 4th dose of Hib before 12 months
the 4th dose of Prevnar before 12 months
the 4th dose of DTaP before 12 months
the 5th dose of DTaP before 4 years
the 4th dose of IPV before 4 years
Sticking to the routine schedule helps to avoid vaccine errors, like giving a vaccine too early. In some situations, the 4 day grace period helps if a vaccine is given a little early.
More on Recommended and Minimum Ages and Intervals Between Doses of Vaccines
As we continue to see outbreaks of vaccine-preventable diseases in the post-vaccination era, it is important that these outbreaks be quickly contained.
But it is important to understand that these outbreaks don’t simply stop on there own. A lot of work goes into containing them.
Working to Contain an Outbreak
And that work containing outbreaks is expensive. Much more expensive than simply getting vaccinated.
For example, the total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC were calculated to be at least $394,448 and 10,054 personnel hours.
Why it is so expensive is easy to see once you understand all of the work that goes into containing an outbreak. Work that is done by your local health department as soon as a case of measles, or other vaccine-preventable disease, is suspected.
Work that, for a measles outbreak for example, includes:
initiating a case and contact investigation
quickly confirming that the patient actually has measles, including testing
assessing the potential for further spread – identifying contacts who aren’t immune to measles and are at risk for getting measles
isolating people with measles and quarantining contacts who aren’t immune to measles for at least 21 days after the start of the measles rash in the last case of measles in the area, including everyone who is intentionally unvaccinated
having targeted immunization clinics in the affected population, such as a school or church, to get as many people vaccinated as possible, even after 72 hours, so they have can be protected in the future
That’s an awful lot of work.
Work that continues until the outbreak officially ends.
Finding the Source of an Outbreak
Another big part of the work that goes on to contain an outbreak is identifying the source of the outbreak.
Was it someone who had recently been traveling overseas, a visitor from out of the country, or someone that was already part of an another outbreak?
Why is that so important?
If you don’t find the source of the outbreak, then you can’t be sure that you have found all of the people that have been exposed, and the outbreak might go on for an extended period of time.
A week after returning home from the trip, he gets sick, but returns to school after a few days. He then develops a rash and sees his family physician, followed by his pediatrician, and then makes a trip to the emergency room because he continues to have a high fever and rash (classic measles symptoms).
He is eventually diagnosed with measles, but not before eleven other children are infected with measles. This includes two of his siblings, five children in his school, and four children who were exposed at his pediatrician’s office.
It is not as simple as that though.
During this measles outbreak:
Three of the children who became infected were younger than 12 months of age, and were therefore too young to have been vaccinated
Eight of the nine children who were at least 12 months old were intentionally unvaccinated because they also had personal belief vaccine exemptions
About 70 children were placed under voluntary quarantine for 21 days after their last exposure because they were exposed to one of the measles cases and either didn’t want to be vaccinated or were too young
One of the infants with measles traveled to Hawaii, raising fears that the measles outbreak could spread there too
All together, 839 people were exposed to the measles virus.
At least one of them was a 10-month-old infant who got infected at his well child checkup, was too young to have gotten the MMR vaccine yet, and ended up spending three days in the hospital – time his parents spent “fearing we might lose our baby boy.”
The parents of this 10-month-old weren’t looking for a vaccine exemption and didn’t want their child to catch measles, a life-threatening, vaccine-preventable disease. Instead, they were counting on herd immunity to protect him until their child could be protected with an MMR vaccine. They were one of “those who come into contact with them” that got caught up in a decision of some other parents to not vaccinate their child.
The kids who are at risk and get a vaccine-preventable disease because they are too young to get vaccinated, have an immune system problem that prevents them from getting immunized or their vaccine from working, and the kids who simply didn’t get protected from a vaccine are the hidden costs of these measles outbreaks that we don’t hear about often enough.
What to Know About Finding the Source of an Outbreak
Without all of the hard work that goes into containing outbreaks, the outbreaks of measles, pertussis, mumps, hepatitis A, and other vaccine preventable diseases would be even bigger.
That measles reduces your risk of cancer is probably one that you haven’t heard.
Neither are you likely to have heard of the conspiracy theory that Big Pharma wants you to get vaccinated and protected so that you don’t get measles, just so you are at increased risk of cancer later.
Does Having Measles Protect You from Cancer?
The idea of a viral infection protecting you from cancer doesn’t make much sense, after all, many viral infections actually cause cancer.
That’s why we have vaccines to protect us against hepatitis B and HPV infections! So much for the idea that Big Pharma wants you to get cancer. If they did, then why did they develop vaccines that prevent cancer?
Kind of. She has a study, “Febrile infectious childhood diseases in the history of cancer patients and matched control,” that was published 20 years ago in the journal Medical Hypothesis. A study that consisted of a questionnaire that was sent to cancer patients who were seen by anthroposophic general practitioners in Switzerland.
Anthroposophic general practitioners? Think Rudolf Steiner and Waldorf Schools.
That’s a risk that you might be unfamiliar with, but it is the increasing popular theory that a natural measles infection resets your immune system to that of a newborn, so that you are once again susceptible to many infectious diseases. That’s likely why mortality rates from other diseases besides measles goes down when folks start to get vaccinated against measles.
Measles and Cancer Risks
What about the association of measles and cancer?
Unlike the idea that a natural measles infection might be protective against cancer, there are more than a few studies that actually associate measles with a risk of developing cancer, including:
Are these associations real?
Probably not, after all, why don’t rates of these cancers go way down after measles gets under control or eliminated?
And we understand the most dangerous association between measles and cancer that affects the most people – when unvaccinated people get measles and expose children and adults on chemotherapy who are immunosuppressed and can’t be vaccinated.
Many news organizations ran with a story about a multi-state measles outbreak recently.
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?
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:
NBC2 – Measles outbreak spreads to 21 states, infecting more than 100 people
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?