If you haven’t guessed yet, as in other countries in Europe, we are seeing more deaths from measles simply because folks aren’t vaccinated and more people are getting measles.
Measles is a life-threatening disease, even in an age of modern medicine, indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, etc.
Italy, with about 1/5 the population of the United States, but about equal to the size of California, has had over 600 times as many cases of measles as we have had in the United States over the last few years. To put it in perspective, that would be like having 33,000 cases of measles in the United States.
But shouldn’t folks have a choice about getting vaccinated?
Even with the new vaccine laws, parents have a choice. As with vaccine laws in the United States, Italy’s new vaccine mandates had nothing to do with forced vaccination.
That’s unlike most of the people who died of measles in Italy. Most of them didn’t have a choice about being vaccinated and getting measles. Some were immunocompromised and couldn’t be vaccinated and at least one was too young to be vaccinated.
Parents had been set a July 10th deadline to provide schools with the relevant documentation, but it will now be possible for parents to simply submit their own confirmation that the child has been vaccinated, according to Giulia Grillo, Italy’s Health Minister, who was speaking at a press conference on Thursday.
Mandatory vaccinations: Italian parents will no longer need to provide doctor’s note
And that’s why it’s unfortunate that the a newly elected government severely watered down a vaccine law that had made getting vaccinated mandatory to go to school.
And it’s unfortunate that people continue to push misinformation about vaccines and vaccine-preventable diseases.
What to Know About the Measles Deaths in Italy
A drop in vaccination rates has led to measles outbreaks and a number of measles deaths in Italy.
And one, the adenovirus vaccine, you can only get if you join the military.
Which Vaccines Do You Get When You Join the Military?
But don’t folks get a lot of vaccines when they join the military?
Whether you join the Army, Navy, Air Force, Marine Corps, or Coast Guard, health personnel will evaluate your immunity status by checking your titers to routine vaccine-preventable diseases. So no, if you were wondering, it doesn’t seem like they just check the vaccine records that you might bring from your pediatrician.
And then once they assess your immunization or immunity status, you will get vaccinated:
upon accession – adenovirus, influenza, meningococcal, MMR, Tdap, and chicken pox
during the first or second half of collective training – hep A, hep B, and polio (if needed) and other vaccines based on risk
So, in addition to getting caught up on all routine vaccines that they might be missing, there are other “military vaccines” that they might need, including:
Anthrax vaccine – only military personnel with extra risk, although some civilians can get this vaccine too
Smallpox vaccine – only military personnel who are high risk and smallpox epidemic response team members, although some civilians can get this vaccine too
Like the recommendations for civilians, other vaccines are mainly given to military personal if they have extra risk based on where they are being deployed.
Cholera – only military personnel with extra risk based on deployment or travel to endemic areas
Japanese encephalitis – only military personnel with extra risk based on deployment or travel to endemic area in Eastern Asia and certain western Pacific Islands
Rabies vaccine – pre-exposure vaccination is only for military personnel with animal control duties or with extra risk based on deployment, including special operations personnel
Typhoid vaccine – only military personnel with extra risk based on deployment or travel to typhoid-endemic areas and other areas with poor sanitation.
Yellow fever vaccine – only military personnel with extra risk based on deployment or travel to yellow-fever-endemic areas in sub-Saharan Africa and tropical South America.
These are the same vaccines that we would get if we traveled to high risk areas.
Military Vaccines in Development
It shouldn’t be a surprise that the military does research on infectious diseases and vaccines.
Members of the military are often put at great risk for known and emerging diseases, like Ebola, Zika, and malaria.
That’s why some vaccines might have been given as an investigational new drug in special situations, typically when “individuals who have a high occupational risk – laboratory workers, facilities inspectors, vaccine manufacturers and certain military response teams.”
These vaccines, which were initially developed at US Army labs, are no longer being produced, but have included:
Argentine hemorrhagic fever (Junin virus) vaccine
Chikungunya fever vaccine
Eastern equine encephalitis vaccine
Q fever vaccine
Rift Valley fever vaccine
Venezuelan equine encephalitis vaccine
Western equine encephalitis vaccine
Today, the Walter Reed Army Institute of Research (WRAIR) “is a leader in global efforts against the world’s most pervasive and high impact infectious diseases.”
WRAIR is working on vaccines for HIV, Ebola, MERS, and Zika.
What to Know About Military Vaccines
You will need some extra vaccines when you enlist in the military, but how many will depend on if you are up-to-date when you join and your area of responsibility. So there is no one-size-fits-all military immunization schedule.
It’s easy to be anti-vaccine when you are hiding in the herd. You don’t get vaccinated and you don’t vaccinate your kids, and instead, you simply rely on the fact that everyone else around you is vaccinated to protect you from vaccine-preventable diseases.
Of course, this is a terrible strategy, as we are seeing with the increase in cases of measles and pertussis, etc. It is much better to learn about the importance and safety of vaccines, get fully vaccinated, and stop these outbreaks.
But as they continue to tell you that vaccines don’t work, how about asking what they would do in these ten high-risk situations?
Amazingly, some folks continue to try and justify skipping vaccines and accept the risk of disease, even when that risk is much higher than usual and they could be putting their child’s life in immediate danger!
How will you do with our quiz?
Would you choose to vaccinate in these situations?
1. Baby born to mother with hepatitis B.
You are pregnant and have chronic hepatitis B (positive for both HBsAg and HBeAg). Should your newborn baby get a hepatitis B shot and HBIG?
Many anti-vaccine experts tell parents to skip their baby’s hepatitis B shot, saying it is dangerous, not necessary, or doesn’t work (typical anti-vax myths and misinformation).
However, it is well known that:
from 10 (HBeAg negative) to 90% (HBeAg positive) of infants who are born to a mother with chronic hepatitis B will become infected
90% of infants who get hepatitis B from their mother at birth develop chronic infections
25% of people with chronic hepatitis B infections die from liver failure and liver cancer
use of hepatitis B immune globulin (HBIG) and hepatitis B vaccine series greatly decreases a newborn’s risk of developing a hepatitis B infection (perinatal transmission of hepatitis B), especially if HBIG and the first hepatitis B shot is given within 12 hours of the baby being born
Would your newborn baby get a hepatitis B shot and HBIG?
2. Your child is bitten by a rabid dog.
Your toddler is bitten by a dog that is almost certainly rabid. Several wild animals in the area have been found to be rabid recently and the usual playful and well-mannered dog was acting strangely and died a few hours later. The dog was not vaccinated against rabies and unfortunately, the owners, fearing they would get in trouble, disappeared with the dead dog, so it can’t be quarantined. Should your child get a rabies shot?
Although now uncommon in dogs, rabies still occurs in wild animals, including raccoons, skunks, bats, and foxes. These animals can then expose and infect unvaccinated dogs, cats, and ferrets, etc.
To help prevent rabies, which is not usually treatable, in addition to immediately cleaning the wound, people should get human rabies immune globulin (RIG) and rabies vaccine.
The rabies vaccine is given as a series of four doses on the day of exposure to the animal with suspected rabies and then again on days 3, 7, and 14.
Although rare in the United States, at least 1 to 3 people do still die of rabies each year. The rabies vaccine series and rabies immune globulin are preventative, however, without them, rabies is almost always fatal once you develop symptoms. A few people have survived with a new treatment, the Milwaukee protocol, without getting rabies shots, but many more have failed the treatment and have died.
Although the first MMR vaccine is routinely given when children are 12 months old, it is now recommended that infants get vaccinated as early as age six months if they will be traveling out of the country.
Since the endemic spread of measles was stopped in 2000, almost all cases are now linked to unvaccinated travelers, some of whom start very large outbreaks that are hard to contain.
Would you both get vaccinated before making the trip?
4. Tetanus shot.
Your unvaccinated teen gets a very deep puncture wound while doing yard work. A few hours later, your neighbor comes by to give you an update on his wife who has been in the hospital all week. She has been diagnosed with tetanus. She had gotten sick after going yard work in the same area and has been moved to the ICU. Do you get him a tetanus shot?
Most children get vaccinated against tetanus when they receive the 4 dose primary DTaP series, the DTaP booster at age 4-6 years, and the Tdap booster at age 11-12 years.
Unlike most other vaccine-preventable diseases, tetanus is not contagious. The spores of tetanus bacteria (Clostridium tetani) are instead found in the soil and in the intestines and feces of many animals, including dogs, cats, and horses, etc.
Although the tetanus spores are common in soil, they need low oxygen conditions to germinate. That’s why you aren’t at risk for tetanus every time your hands get dirty. A puncture wound creates the perfect conditions for tetanus though, especially a deep wound, as it will be hard to clean out the tiny tetanus spores, and there won’t be much oxygen at the inner parts of the wound.
These types of deep wounds that are associated with tetanus infections might including stepping on a nail, getting poked by a splinter or thorn, and animal bites, etc. Keep in mind that some of these things, like a cat bite, might put you at risk because you simply had dirt/tetanus spores on your skin, which get pushed deep into the wound when the cat bites you.
Symptoms of tetanus typically develop after about 8 days and might include classic lockjaw, neck stiffness, trouble swallowing, muscle spasms, and difficulty breathing. Even with treatment, tetanus is fatal in about 11% of people and recovery takes months.
Would you get your teen a tetanus shot?
5. Cocooning to protect baby from pertussis.
Both of your unvaccinated teens go to school with a personal belief vaccine exemption. You are due in a few months and are a little concerned about the new baby because there have been outbreaks of pertussis in the community, especially at their highschool. Should everyone in the family get a Tdap shot?
Pertussis, or whooping cough, classically causes a cough that can last for weeks to months.
While often mild in teens and adults, pertussis can be life-threatening in newborns and infants. In fact, it is young children who often develop the classic high-pitched whooping sound as they try to breath after a long coughing fit.
In a recent outbreak of pertussis in California, 10 infants died. Almost all were less than 2 months old.
Since infants aren’t protected until they get at least three doses of a pertussis vaccine, usually at age 6 months, experts recommend a cocooning strategy to protect newborns and young infants from pertussis. With cocooning, all children, teens, and adults who will be around the baby are vaccinated against pertussis (and other vaccine-preventable diseases), so that they can’t catch pertussis and bring it home.
There is even evidence that a pregnancy dose of Tdap can help protect infants even more than waiting until after the baby is born to get a Tdap shot.
Would everyone in your family get a Tdap shot?
6. Nephew is getting chemotherapy.
Your nephew was just diagnosed with leukemia and is going to start chemotherapy. Your kids have never been vaccinated against chicken pox and haven’t had the disease either. Your brother asks that you get them vaccinated, since they are around their cousin very often and he doesn’t want to put him at risk.
Do you get your kids vaccinated with the chicken pox vaccine?
Kids with cancer who are getting chemotherapy become very vulnerable to most vaccine-preventable diseases, whether it is measles, flu, or chicken pox.
According to the Immune Deficiency Foundation, “We want to create a ‘protective cocoon’ of immunized persons surrounding patients with primary immunodeficiency diseases so that they have less chance of being exposed to a potentially serious infection like influenza.”
Would your get your kids vaccinated with the chicken pox vaccine?
7. Outbreak of meningococcemia at your kid’s college.
Background information: Neisseria meningitidis is a bacteria that can cause bacterial meningitis and sepsis (meningococcemia).
Depending on the type, it can occur either in teens and young adults (serogroups B, C, and Y) or infants (serogroup B).
Although not nearly as common as some other vaccine-preventable diseases, like measles or pertussis, it is one of the more deadly. Meningococcemia is fatal in up to 40% of cases and up to 20% of children and teens who survive a meningococcal infection might have hearing loss, loss of one or more limbs, or neurologic damage.
Meningococcal vaccines are available (Menactra and Menveo) and routinely given to older children and teens to help prevent meningococcal infections (serogroups A, C, Y and W-135). Other vaccines, Bexasero and Trumenba, protect against serogroup B and are recommended for high risk kids and anyone else who wants to decrease their risk of getting Men B disease.
Would you encourage her to get vaccinated against meningococcemia?
8. Cochlear implants.
Your preschooler has just received cochlear implants. Should he get the Prevnar and Pneumovax vaccines?
Cochlear implants can put your child at increased risk for bacterial meningitis caused by the Streptococcus pneumoniae bacteria (pneumococcus).
Your child is going to have his spleen removed to prevent complications of hereditary spherocytosis. Should he get the meningococcal and pneumococcal vaccines first?
Without a spleen, kids are at risk for many bacterial infections, including severe infections caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
In addition to their routine vaccines, kids with asplenia might need Menveo or Menactra, Bexsero or Trumenba (Men B), and Pneumovax 23.
Would your child get these vaccines that are recommended for kids with asplenia?
Ebola is returning, but this time an experimental vaccine is available.
There were nearly 30,000 cases and just over 11,000 deaths during the 2014-16 Ebola outbreak in West Africa.
You are in an area that is seeing an increasing number of Ebola cases and there is still no treatment for this deadly disease. An experimental vaccine is being offered.
Do you get the vaccine?
How Anti-Vaccine Are You?
It’s easy to be anti-vaccine when you are hiding in the herd – seemingly protected by all of the vaccinated people around you.
While the oral polio vaccine is indeed associated with shedding and vaccine associated disease, that doesn’t happen with MMR. Experts don’t even recommend any restrictions for use of the MMR vaccine for household contacts of people who are immunosuppressed. And yes, your kids can even visit a cancer patient if they just had their MMR, as long as they don’t have RSV, the flu, or some other contagious disease.
What about the fact that a study once found measles virus RNA in the urine of of kids who had recently been vaccinated? Doesn’t that mean that they were shedding the vaccine virus?
No. It doesn’t.
To be considered shedding, those measles virus RNA particles in their urine would have to be contagious. Now, measles is spread by respiratory secretions. So how are measles virus RNA particles in urine going to become airborne and get someone else sick?
But what about that case in Canada? Anti-vaccine folks like to bring this up when they talk about shedding. In 2013, there was a case of vaccine-associated measles. That proves that the vaccine sheds, right?
“Of note, only one case report of transmission from vaccine-associated measles has been identified.”
Murti et al. on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013
That child got measles about 5 weeks after she was vaccinated in the middle of a measles outbreak. Because she had no links to the other cases and she tested positive for vaccine-strain measles, it is thought that she had MMR vaccine-associated measles, which is extremely rare.
Shedding Light on Measles Outbreaks in Daycare
MMR shedding is not causing outbreaks of measles – or rubella and mumps, for that matter.
If shedding from the MMR, by any method, got kids sick, then why aren’t there even more cases of measles?
When a case of measles does pop up though, it isn’t because of shedding, it is typically because someone who wasn’t vaccinated traveled out of the country, got measles, and brought it back home, exposing others.
What to Know About MMR and Shedding
Measles outbreaks are not caused by shedding from the MMR vaccine.
Breaking News – There are now six cases of measles in the San Francisco Bay Area, all unvaccinated, in an ongoing outbreak that has also spread to Nevada.
Is anyone surprised that a student in California has measles?
Actually, a lot of folks are probably surprised. After all, didn’t lawmakers in California recently pass a law that mandated everyone in school get vaccinated?
Well yeah, but SB277 didn’t apply to all students. Only new students and those transitioning to a new grade span (for example, moving from K-6th to 7th grade) have to meet the new minimum immunization requirements. That means it will take more than a few years until all of the kids already in school whose parents have skipped or delayed any vaccines have gotten caught up or have graduated.
When you think of measles and California, most people probably think of the 2015 Disneyland outbreak, which was linked to:
134 cases in California, including at least 50 cases without a known source
13 cases in Arizona, Nebraska, Utah, Colorado, Washington, and Oregon
1 case in Mexico
159 cases in Canada
The Disneyland outbreak included a lot of intentionally unvaccinated kids and kept unvaccinated kids from school, closed daycare centers, and led to hospitalizations of more than a few people.
“The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents.”
Majumder et al. on Substandard Vaccination Compliance and the 2015 Measles Outbreak
The Disneyland outbreak wasn’t the first big measles outbreak in California in recent years though.
No, I’m not talking about the really big outbreaks from the pre-vaccine era. Or even the outbreaks in the late 1980s, just before we started giving an MMR booster. Believe it or not, 75 people died between 1988 and 1990 with measles – just in California.
More recently, there was the 2008 outbreak in San Diego that was triggered by an unvaccinated 7-year-old boy who had traveled to Switzerland with his family.
He returned with measles and got at least 10 other unvaccinated children sick, including four infants who were too young to be vaccinated and were unknowingly exposed at their pediatrician’s office.
“Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears…”
OC’s Dr. Bob Sears discusses measles outbreak on NPR
One of those infants was hospitalized when his fever spiked to 106 degrees and he wouldn’t eat or drink.
“We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately.”
Megan Campbell on 106 Degrees: A True Story
Measles cases also began rising in 2011, as unvaccinated travelers brought measles back from trips to Europe, Asia, and Africa, where there were large outbreaks. There were 31 measles cases in California in 2011.
While 31 cases might not seem like much, consider that between 2001 through 2006, there were just 66 cases in California, with only 4 cases in 2005!
Will we ever get to a year with just 4 cases in California again?
It didn’t happen in 2017.
Last year started with a big outbreak in Los Angeles County that grew to include at least 24 cases and a few surrounding counties. There was also a case involving an unvaccinated student at Laguna Beach High in Orange County which led to the quarantine of at least 6 unvaccinated students.
The Latest California Measles Outbreak
What kind of a measles year will we see in 2018 in California?
It started when an unvaccinated student returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County at a school in Campbell and at the Westgate Center food court in San Jose.
With an average incubation period of 10 to 12 days, that means exposed people might begin to show symptoms by March 14. Keep in mind that the incubation period can be as long as 21 days though, so be on the watch for measles symptoms until at least March 23 if you could have been exposed.
Since we don’t know when the new cases began to show symptoms, it is hard to know how much longer we can expect to see new cases. Hopefully these folks were already in quarantine and didn’t expose anyone else.
Would you recognize measles?
It is important to understand that the first symptoms of measles don’t include a rash. Instead, you get a high fever, runny nose, cough, and pink eye. The measles rash comes a few days later, as the high fever continues.
It is also important to understand the the MMR vaccine is safe and works very well to prevent measles.
This exposure is a great reminder that vaccines are necessary and that you shouldn’t wait for your kids to get exposed to get them caught up and vaccinated and protected.
What to Know About Measles Outbreaks in California
A recent outbreak of measles in California, this time in Santa Clara County, is a good reminder that the MMR vaccine is necessary to keep your kids protected.
In the United States, it was actually eliminated by controlling the Aedes aegypti mosquitoes that spread the yellow fever virus before the vaccine was even developed. These control efforts were also done in Cuba, Panama, and Ecuador, etc., places where yellow fever was common and led to outbreaks in the United States.
Why Haven’t We Eradicated Yellow Fever?
So why is yellow fever still a problem if we can control the the Aedes aegypti mosquitoes that carry the yellow fever virus?
“Mosquitoes breed in tropical rainforests, humid, and semi-humid environments, as well as around bodies of still water in and close to human habitations in urban settings. Increased contact between humans and infected mosquitoes, particularly in urban areas where people have not been vaccinated for yellow fever, can create epidemics.”
Yellow fever: Questions and Answers
It’s because we can control the mosquitoes in urban areas, in and around cities. You can’t really control or eliminate mosquitoes in tropical rain forest regions, which is why it is difficult to eradicate yellow fever, malaria, dengue fever, and other mosquito borne diseases.
But we have a vaccine, don’t we?
“Eradication of yellow fever is not feasible since we are unable to control the virus in the natural animal hosts.”
Yellow fever: Questions and Answers
Unfortunately, we aren’t the only ones who can become infected with yellow fever. Monkeys get infected with the yellow fever virus in rain forests, infect Haemagogus and Sabethes mosquitoes, which bite people in those areas.
“Urban transmission of yellow fever virus occurs when the virus is spread from human to human by the Aedes aegypti mosquitoes.”
Yellow fever – Brazil
That likely means that yellow fever will never be completely eradicated, unlike small pox.
Yellow Fever Vaccines Myths
But just because yellow fever can’t be eradicated doesn’t mean that it can’t be eliminated.
A single dose of the yellow fever vaccine is safe and provides life-long protection for 99% of people.
“Vaccination is the most powerful known measure for yellow fever prevention: a single dose can provide life-long immunity at a cost of approximately US$1.”
WHO on Eliminating Yellow Fever Epidemics (EYE) Strategy: Meeting demand for yellow fever vaccines
And as cases of yellow fever increase in some countries, like Brazil, getting more people vaccinated is the only way to stop this deadly disease.
You should not skip getting the yellow fever vaccine if you are traveling to an area where yellow fever is endemic, including many parts of areas of Africa and South America.
While you are most at risk during the rainy season, especially during outbreaks, it is also possible to get yellow fever during the dry season.
Yellow fever is a serious, life-threatening disease.
There is no cure for yellow fever.
While serious side effects to the yellow fever vaccine have been reported, including anaphylaxis, yellow fever vaccine-associated neurologic disease (YEL-AND), and yellow fever vaccine-associated viscerotropic disease (YEL-AVD), they are very rare.
The yellow fever vaccine is a live virus vaccine, but shedding is not an issue. Unless at a high risk of exposure, getting the yellow fever vaccine is usually not recommended if you are pregnant or breastfeeding though.
It is not usually necessary to get a booster dose of the yellow fever vaccine.
Some countries require proof of yellow fever vaccination if you have traveled from a country where there is still a risk of getting yellow fever, so that you don’t import yellow fever into their country.
As yellow fever cases are on the rise in Brazil, with an associated increase in travel associated cases, it is important that everyone understand that vaccines are safe and necessary.
What to Know About Yellow Fever Vaccine Myths
Yellow fever cases are increasing and so are anti-vaccine myths about the yellow fever vaccine, which are keeping some folks from getting vaccinated and protected, even as they are threatened by a potential outbreak.