Tag: sanitation

Remembering Measles

I don’t remember treating any kids with measles in medical school or residency.

We certainly saw a lot of other now vaccine-preventable diseases when I was in training, from rotavirus and pneumococcal disease to meningococcal disease.

“When I graduated from medical school, many of the current vaccines were either not yet invented or just beginning to be widely used. I still remember what health care was like in the pre-vaccine era, and I remember that there seemed to be at least one child in each neighborhood who spent much of her life in an iron lung because of polio. As a young resident in pediatrics, I heard, on the whooping-cough ward, the coughing and choking of children with pneumonia. I remember the brain damage from encephalitis caused by measles, and the birth defects of babies whose mothers had had German measles during pregnancy. In my first years in pediatric practice, I remember making hospital rounds every morning and treating children with meningitis, and complications of chicken pox and other illnesses that have been either eliminated or lessened in severity by the widespread use of vaccines. Also, I remember more than a decade ago when Great Britain temporarily stopped the routine use of the DTP vaccine because of a reaction scare (which later turned out to be a false alarm) and consequently suffered a resurgence of whooping cough. Because of my “historical” perspective, I have grown to appreciate the value of vaccines as a necessary public-health measure. Currently in our pediatric practice, we follow the vaccine schedule recommended by the American Academy of Pediatrics.”

Dr. William Sears on Ask Dr. Sears: Vaccination/Immunization Concerns

But I trained in the post-elimination era for measles.

Remembering Measles

Although some folks only seem to have the Brady Bunch to use as a guide, fortunately there are many other ways to discover what measles used to be like.

I asked some of my old instructors…

“Typical case of measles – a couple days of high fever, with a sick (miserable) looking kid with running nose, bad cough, and red eyes. You can see Koplik’s spots if you know to look for them on the buccal mucosa (I describe them as grains of salts on red tablecloth). Fever gets higher and rash appears at peak of fever (day 3-4). The rash disappears with a brawny hyperpigmented appearance. The child frequently gets diagnosed with an ear infection. If no complications (ear infection or pneumonia), recovery is quick once the fever resolves, but these kids look really sick, miserable, and sad during the acute phase. They have a measly look.”

Jeed Gan, MD

After reading that account, I’m glad my kids are all vaccinated and protected and hopefully won’t ever get measles, as it sounds horrible.

Although I have never seen it, I can certainly imagine that measly look…

A child with measles and four days of the classic measles rash.
A child with measles and four days of the classic measles rash. Photo by CDC/NIP/ Barbara Rice

What else can you imagine?

“I’ve often called measles ‘the harmless killer’ because, although most youngsters recover uneventfully, the disease a certain amount of really serious damage.”

Dr. Joseph Molner

Can you imagine intentionally leaving your kids unvaccinated and at risk of a harmless killer disease?

In this 1959 article in the Madera Tribune, Dr. Bundesen warns parents to take measles seriously.
In this 1959 article in the Madera Tribune, Dr. Bundesen warns parents to take measles seriously.

It is important to note that even a “mild” attack included a fever that could hit 104F or higher and, altogether the symptoms could last up to 12 days, as the cough often lingers after the rash has cleared up.

Measles is definitely contagious.
Measles is definitely contagious.

And in the pre-vaccine era, everyone ended up having measles, as it was so contagious.

Not everyone survived having measles though.

Even after improved sanitation and hygiene dropped mortality rates for measles and other diseases in the early part of the 20th Century, a lot of kids still died with measles.
Even after improved sanitation and hygiene dropped mortality rates for measles and other diseases in the early part of the 20th Century, a lot of kids still died with measles.

It was once well known that measles was not always so easy on kids.

1953 medical advice column
1953 medical advice column

Why have so many folks forgotten that fact?

Do you think that a 106F fever comes with a mild disease?
Do you think that a 106F fever comes with a mild disease?

Is it because vaccines work so well that we don’t see or hear about measles that much anymore?

Kids with measles feel awful.

At least we don’t hear about them until immunization rates drop and we start having more and more outbreaks.

Is that what it’s going to take to get you to vaccinate your kids? An outbreak in your city? Your child’s school? Or are you going to wait until your kids get sick?

More on Remembering Measles

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Anti-vaccine folks have gotten pretty good at pushing propaganda to keep you scared to vaccinate and protect your kids.

Now, they even have quizzes to help test how much of that misinformation you remember!

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

A quiz about measles outbreaks by the ironically named Physicians for Informed Consent was recently promoted by Dr. Bob Sears.

How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?
How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?

Let’s take a look at some of the questions and the anti-vaccine answers

There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.
There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.

While mortality rates did indeed decline for most diseases and conditions in the early part of the 20th century because of advancements in living conditions, nutrition, and health care, that effect had plateaued by the mid-1930s.

Being unvaccinated and unprotected is the main reason why people in underdeveloped countries die from measles, not low vitamin A…

It is true that vitamin A deficiency increases the risk for more severe complications and death from measles, which is why it can be more deadly in undeveloped countries where malnutrition is a big problem.

“Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.”

Measles cases spike globally due to gaps in vaccination coverage

Unfortunately, the other big problem in many of these countries is that these kids are unvaccinated because of a lack of access to vaccines.

This child doesn’t appear to have measles…

Immune globulin is a treatment option if you have been exposed to measles, but it is not actually a treatment once you have measles. And high dose vitamin A mainly benefits those with a vitamin A deficiency, which is unlikely in an industrial country, like the United States.

The only benefit of having measles, which you have to earn by having measles and surviving without complications, is that you will have developed immunity to measles.

In addition to having no other benefits, you will then be at risk for SSPE and may have wiped out your immune system for a few years.

While you are at risk for encephalitis and seizures after a natural infection, after getting a dose of MMR, one risk is a febrile seizure, which is typically thought to be benign.

The risk of having a febrile seizure after the first dose of the MMR vaccine is about 1 in 2,500 doses. There is also a small risk of having a febrile seizure if the flu vaccine is given at the same time as a Prevnar or DTaP vaccine.

It is important to note that vaccines are not the only reason that children have febrile seizures. Many infections, including vaccine preventable infections, can trigger febrile seizures, in addition to causing more serious types of non-febrile seizures.

This is not true.

It is very unlikely that any of the kids who develop febrile seizures after a vaccine will later develop epilepsy.

“Febrile seizures can be frightening, but nearly all children who have a febrile seizure recover quickly, are healthy afterwards, and do not have any permanent neurological damage. Febrile seizures do not make children more likely to develop epilepsy or any other seizure disorder.”

Febrile Seizures Following Childhood Vaccinations, Including Influenza Vaccination

Without any risk factors (parent or sibling with epilepsy, having complex febrile seizures, or abnormal development), a child with febrile seizures has the same risk of developing epilepsy has any other child.

Do anti-vaccine folks really read the inserts?

Like many other vaccines, the package insert for MMR does say that it has “has not been evaluated for carcinogenic or mutagenic potential, or potential to impair fertility.” That doesn’t mean that it hasn’t undergone safety studies for its potential to cause cancer, genetic mutations, and impaired fertility though.

Wait, what? Yeah, all vaccines have preclinical toxicology studies, including single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any issues are found, further studies are done.

The only way to think that a natural measles infection is safer than the MMR vaccine is if you believe that all reports to VAERS have been confirmed as being caused by the vaccine (they aren’t) and you don’t think about the fact that relatively few people get measles any more (so you don’t see or hear about many measles deaths) because most folks are vaccinated and protected!

How did you do on the quiz?

Did you easily spot all of the anti-vaccine propaganda?

More on Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Did the Measles Vaccine Have Only a Meager Effect on Deaths?

Anti-vaccine folks seem to think that they found another big bombshell report!

As you will see, the “meager effect” of the measles vaccine prevented over 500 measles deaths in the United States each year!

They are talking about an article from 2001, The Role of Public Health Improvements in Health Advances: The 20th Century United States, by David Cutler, which found that “clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction.”

The article even included mortality graphs for anti-vaccine folks to misuse!

Did the Measles Vaccine Have Only a Meager Effect on Deaths?

What are they missing?

“In the early 20th Century, mortality in the United States declined dramatically. Mortality rates fell by 40% from 1900 to 1940, an average decline of about 1% per year”

Cutler on The Role of Public Health Improvements in Health Advances: The 20th Century United States

Most of the decline the article talks about came at the beginning of the 20th Century, before these vaccines were developed.

What about the vaccines for whooping cough, diphtheria, and tetanus, which were developed in the earlier part of the 20th Century? They weren’t routinely used until much later. Remember, the individual diphtheria, tetanus, and pertussis vaccines didn’t even become combined into a single DTP vaccine until 1948.

Clean water and sanitation only had so much effect on mortality rates and much of it was in the early part of the 20th Century. Vaccines and other medical interventions took us the rest of the way!

But, all of these diseases that are now vaccine preventable were still very deadly in the 1940s and 1950s, even with clean water and sanitation.

Sure, mortality rates had declined already by this time, just like they had for most other things, but the effects of clean water eventually plateaued and a lot of people were still getting measles and a lot of people were still dying.

Why so many deaths in 1950 if they had been eliminated by clean water and sanitation?

At least they were until the measles vaccine was discovered and more and more people started getting vaccinated and protected.

You can even ask the author of the article in question…

“Dear Lord.  The fact that vaccines aren’t the only reason why mortality declines in no way means that vaccines are not an important reason why mortality declines.”

David M Cutler, Harvard College Professor, Otto Eckstein Professor of Applied Economics

The idea that the measles vaccine had only a relatively meager effect on deaths due to measles infections is silly. It’s also dangerous if you believe it and leave your kids unvaccinated and at risk to get measles, which is clearly a deadly disease.

More on Anti-Vaccine Mortality Graphs

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

A Crazymother Visits Her Pediatrician to Talk About Vaccines

There is a new Crazymothers video floating around and it is everything that’s wrong with the modern anti-vaccine movement.

What is so shocking about a pediatrician educating a mother about the importance of vaccinating and protecting her child?
What is so shocking about a pediatrician talking to a mother about the importance of vaccinating and protecting her child?

On the fence parents are being told ‘this this and this’ by their pediatricians and then going to someone who has found Internet fame making Crazymothers videos to find out if they are true.

As you might expect, her videos include:

She even defends Andrew Wakefield and doesn’t believe that people died of measles once MMR vaccination rates went down after Wakefield’s study was published.

A Crazymother Visits Her Pediatrician to Talk About Vaccines

Crazymothers?

As someone who is mindful that language can promote stigmas and stereotypes, it is not a term that I chose.

It is the name of a parenting group.

Wait until you hear what this pediatrician has to say when a Crazymother informs her she will no longer be vaccinating!

“Ok, today is just a hepatitis vaccine.”

I have made the decision that I no longer want my kids to be vaccinated.

“At all?”

At all. So, I know that’s not what you want to hear.

“It isn’t. It scares me. It scares me a lot.”

I know. I hear that, but I also have to do what I feel is best.

“Is there a specific concern that you have?”

Oh, there is a lot of things.

“What are they?”

There’s a lot. I’m worried about a lot. I wasn’t planning on having this conversation today. I didn’t know he was getting a shot. I wasn’t prepared. I thought he coming in for a blood test today. There’s a lot of reached out and met a lot of other moms who just have a lot of really sad stories and I just kind of started doing my own research and I just don’t feel like it is best for my kids and … I’m very concerned for his health and him getting vaccinated with all of these problems that he already has isn’t going to benefit him right now so I may change my mind down the road.

That last paragraph says an awful lot about why some parents are choosing to delay or skip their children’s vaccines:

Mostly they are scared. Hopefully this mom does some more research, gets more answers to her questions, and does change her mind soon.

Crazymothers Propaganda

The video, most which I have transcribed, also illustrates why it is important to be prepared when you talk to your pediatrician about vaccines.  After all, you can’t get your questions about vaccines answered if you don’t ask any questions.

“So my job at every visit is to let you know what you are declining and what we’re trying to protect against. It’s also very important if you decide not to immunize to remember that he’s at risk for a lot of other things so if he gets a fever its going to mean something different to mean than a child who is fully immunized as a fever… so if you call us after hours and he has a fever, make sure you tell us, oh by the way, he isn’t immunized…”

How does it mean something different if a child is intentionally not vaccinated?

It is actually very simple.

They are at increased risk for vaccine-preventable diseases.

While a vaccine-preventable disease should be in the back of your mind for any kid if their symptoms fit the disease, since vaccines aren’t 100% effective, they move higher up your list of possibilities if you know the child is unvaccinated and unprotected.

“I also just want to tell you that there’s a very big difference between anecdotal evidence and population based evidence, so just because someone has a sad story doesn’t mean that what happened to them is truly related to the vaccine.”

yeah

“And also keep in mind that in terms of autism, the study that was done in England years ago that supposedly linked autism to the measles, mumps, and rubella vaccine was tainted. It was funded by anti-vaccine lawyers, was retracted by every single person that offered that study and because of that study, children didn’t get the MMR and many died.”

Crazymothers – OMG, I can’t even with this… She said that children didn’t get the MMR and many died. That’s not true. If you look at the cases of measles after 1998 when the Lancet study was published the measles cases actually went down. Nobody died. Nobody has died in America for years and years from the measles. It is completely silly.

Nobody died?

Measles cases went down?

“Between 2001 and 2013 there was a sharp rise in the number of UK measles cases, and three people died.”

Current measles risks in the UK and Europe

As most folks now, before Wakefield was stripped of his medical license, he practiced in the United Kingdom, and not surprisingly, that’s where we saw a big effect on MMR rates. They went down and measles cases went up.

MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn't fully recover until 2012.
MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn’t fully recover until 2012.

But even as measles cases and deaths have gone down globally, measles outbreaks and measles deaths have been much worse in the rest of Europe.

Even in the United States, cases have gone way up since we hit a record low of 37 cases in 2004 and there have been deaths, with the last in 2015.

“Again, this was very contentious and you would not get consensus from all members of the group on this, but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.”

Andrew Wakefield

It is amazing how many times you hear the phrase “that’s not true” in this video about things that are so easy to confirm as facts.

“Continue to give it some thought because to me vaccines are modern miracles and it scares me to death to have people not getting vaccinated… He’ll probably be okay, but that’s because I’ve vaccinated my kids the other day, so we’re protecting your kid… The more people who stop doing it, forget about it, it’s going to go back to the old days where people are dying all of the time.”

Crazymothers – There’s that herd immunity myth. She says that your kid is going to be okay because I’m doing the right thing. I’m vaccinating my child. And anybody who studies this knows that’s not true! Herd immunity is a myth. Go outside and talk to a 30-year-old, 40-year-old, 50-year-old, who hasn’t been recently vaccinated and you can clearly see, plain as day…

As far as I know, we have indoor plumbing, we have sewage systems, we have clean water, and we have access to whole foods, we have ways to supplement with vitamins and minerals, we have all of these amazing things and that is what actually brings disease rates down.

Proper sanitation, sewage systems, all of the modern things that we take for granted – that is what is actually bringing the disease down, because clearly, in under-developed countries, we still see the diseases rampant, right?

Herd immunity myth?

The idea that herd immunity is a myth because adults aren’t vaccinated is silly.

Adults were either born in the pre-vaccine era and likely have natural immunity or were born in the vaccine era and are vaccinated and immune, as many vaccines provide life-long immunity. That’s why adults get few boosters or catch-up vaccines.

But herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if someone has immunity against hepatitis A or Hib. Also, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.

There is only clearly one modern thing that that anti-vaccine folks take for granted – vaccines.

My uncle got polio around 1950, in Brooklyn, just before the first polio vaccine was developed.

You know what?

They had indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, and medicine – he was hospitalized for six months – yet many people still died of polio.

In 1951, during the first season of I Love Lucy, you can see that they had indoor plumbing. Surprised?
In 1951, during the first season of I Love Lucy, you can see that they had indoor plumbing. Surprised?

At that time, during the pre-vaccine era, many people also died of measles, tetanus, pertussis, chicken pox, and many other diseases that are now prevented with vaccines.

In 1954, Lucille Ball and Desi Arnaz asked everyone to “give every dime and dollar” they could spare to fight polio.
In 1954, Lucille Ball and Desi Arnaz asked everyone to “give every dime and dollar” they could spare to fight polio.

And unfortunately, many under-developed countries still don’t have proper sanitation, sewage systems, or good nutrition, but do you know what they also don’t have?

Polio.

We are very close to eradicating polio all over the world. Only two countries, Afghanistan and Pakistan still have cases of wild polio today. And so far this year, there have only been 11 cases. Did every other country in the world suddenly get proper sanitation, sewage systems, and good nutrition? Is that why we are so close to eradicating polio?

Of course not. It’s the polio vaccine.

Vaccines work. Vaccines are safe and necessary. They have few risks and many benefits. You won’t learn any of that from the Crazymothers group and that’s likely why you have made the decision that you no longer want your kids to be vaccinated.

What to Know About Crazymothers Propaganda

Don’t let Crazymothers propaganda scare you away from vaccinating and protecting your kids.

More on Crazymothers Propaganda