Vaccines: Measles in America

By: Mariah Brashar, Public Affairs Producer

Courtesy of the Washington Post: http://www.washingtonpost.com/news/to-your-health/wp/2014/05/29/u-s-measles-outbreak-sets-record-for-post-elimination-era/

Courtesy of the Washington Post: http://www.washingtonpost.com/news/to-your-health/wp/2014/05/29/u-s-measles-outbreak-sets-record-for-post-elimination-era/

In light of the recent measles outbreak at Disney Land in California, vaccines are a hot button issue for a lot people on both sides of the to-vaccinate or not-to-vaccinate debate.  Concern about the so called “anti-vax” movement and the affects the movement might have on the health of our society has had quite a bit of play in the media over the last few weeks.  Like everything from abalone to ziggurats, if a person looks online she can find a lot of information about vaccines, from both sides.  The trick is figuring out what information comes from a trust-worthy source and what information…well, doesn’t.

The first thing I realized was that I don’t even know what the measles really even is.  I’ve always imagined it as kind of like the chicken pox, but when you get right down to it, all I know about the chicken pox is that it’s itchy.  So, for all of you out there like me, here’s a quick run down of what the measles really looks like.

It starts with cold-like symptoms: watery eyes, a cough, and a fever, often a pretty high fever, around 104 degrees.  Then, whitish mouth sores, called Koplik spots form and a red rash begins on the face and neck and spreads to the rest of the body.  A child with the measles is totally miserable, but generally recovers in about ten days.

About eight percent of measles cases develop diarrhea, which can lead to dehydration.  About seven percent develop an ear infection, which can lead to deafness.  About six percent develop pneumonia, which is actually what generally kills a person with the measles.  In rare cases (about one in every 170), a person with measles can develop seizures.  In even more rare cases (about one in every thousand people) measles can cause swelling of the brain or acute encephalitis.  Out of people who develop encephalitis, about 15 percent die–in other words around one in 7,000 people who developed measles would likely die from encephalitis.  There also can be, in rare cases, complications that take place years after recovering from the measles.

The one of the most disturbing of these is a brain inflammation, which nearly invariably leads to death, that can manifest itself up to ten years after recovery.  In other words, measles can be pretty awful.

Before the measles vaccine, about four million people in the US got the measles each year, out of that four million, about 48,000 were hospitalized.  That’s a little less than one in eight people who got the measles had to stay in the hospital.  Out of those who were hospitalized, about 500 died.

In an interview with Huffington Post live, Melinda Gates, the co-chair of the Bill and Melinda Gates foundation, explains why she think American parents question vaccination against measles.  She said that American parents have forgotten what death from the measles looks like.

That makes sense, actually.  When I consider the fact that, before this story, I really didn’t even know what the measles looked like, much less an actual fatal case of the disease.  After all, the measles vaccine has been distributed in the United States since the early sixties: before that, measles was a common childhood disease.

As discussed, in the pre-vaccine era, the vast majority of American children did not die from the measles, nor did the majority suffer from lasting side effects like deafness.  This, in fact, is one of the arguments that those who oppose vaccination make.  The website VAXTRUTH.org uses the statistical likelihood (which was about three deaths out of every 2,000 cases of measles)  to show that measles shouldn’t be feared today.  Seems reasonable enough, though three out of 2,000 isn’t exactly that great of odds.  After all, people still freak out about dying in a plane crash and the odds of that are about one in 11 million, according to a report in the International Business Times.

To explain why the medical community feels that vaccination is so vital, even given the fairly low chance of death,  I spoke to my friend Corrine Johnson.  Corrine has been a pediatric nurse in Anchorage for the last 13 years and worked in pediatrics as a medical assistant for the 20 years before that.  I asked her what her take was on the actually relatively low risk of death from measles.  She told me that looking only at death is really a narrow way to look at the affects of a disease.

As a student nurse, Corrine treated a five-month-old baby for pertussis, more commonly known as whooping cough.  Children cannot be vaccinated against whooping cough until they reach 12 months.  As with most diseases, the younger a baby is, the more dangerous a disease can be for him or her.  This particular baby that Corrine treated spent two months in the hospital with two collapsed lungs.  The child’s family lost their home due to medical expenses.  Corrine said that they would never be able to pay for their children to go to college because they would be paying off the debt for the rest of their lives.  And, that doesn’t even mention the emotional cost of having a child so near death.

So, the cost, even aside from complications or death, can be pretty tremendous.  The price of medical care in this country is a whole other story, but suffice it to say for now that, if your child has to stay in the hospital for any extended period of time, your wallet is not going to be happy about it.

Now, lets slip over the fence for a minute.  There are a couple of pretty hard to ignore arguments from the Anti-Vaccine movement. For one thing, there can be complications. And, those complications can sometimes be severe–ranging from allergic reactions (which generally can be treated fairly easily) to permanent physical damage.  However, there are inherent, if very unlikely, risks with every single medical procedure.  Another nurse I spoke with made this analogy:

If you get in a car crash, it is possible that you could be killed by your seat belt.  It happens, very very rarely, but it’s possible.  Not vaccinating because of the risk of complication is like not ever wearing your seat belt because there’s a possibility it could hurt you.  In the vast, vast majority of cases, your seat belt protects you, but there’s a chance it will do the opposite.

Corrine said that the risk of vaccine complication was minuscule compared to the risk of being infected with a preventable disease.  She explained that vaccines work best when almost all of the population is immunized, because there will be some people, albeit very few, who cannot be safely vaccinated.

Another understandable concern for parents is the way that vaccinations are given to tiny babies and the rate and frequency at which infants receive these shots.  Some are also concerned about the chemical contents included in vaccines.  The anti-vaccine documentary Silent Epidemic, the Untold Story of Vaccines discusses how many vaccines children are exposed to and how rapidly they are exposed.

It’s easy to sympathize with this side of the argument, but Corrine had some insight to offer about the schedule.  She said that immunization schedules were designed to provide maximum immunity with minimum risk to children.  Corrine asked, why would you wait?  A vaccine can save your child’s life and keep them safe.  Why would a parent procrastinate that, when it has been proven to be safe to be administered earlier?

Another concern some people have about vaccinating babies and young children stems from a belief that certain vaccines may cause autism.  In 1998, Dr. Andrew Wakefield published a research paper that linked the MMR (or measles mumps and rubella) vaccine to the onset of autism.  After more than a decade, and more than 2 dozen studies were done attempting and failing to replicate Wakefield’s results, his study was thoroughly discredited in 2011.  However, the fear of vaccine-induced autism persists.

In 2011, NPR’s DIANE REHM hosted a panel of experts on the subject.  One of her guests, Seth Mnookin, explained that in addition to the scientific communities’ inability to replicate Wakefield’s study results, Wakefield also had several financial conflicts of interest.

Another guest on the show, Alison Singer, explained it simply.  She said “The way science needs to be done is when a scientific question is put before us and there’s one study, that study needs to be replicated and several laboratories set out specifically to try to replicate Wakefield’s findings and none could. And we got to the point where we had study, after study, after study that looked at whether vaccines were associated with autism and none of the studies indicated that there was a cause or relationship between vaccines and autism.”

Here in Alaska, the vaccine debate it particularly pertinent.  According to the CDC in 2013, Alaska had the lowest rate for the combined childhood vaccine series, with only about 60 percent of children fully vaccinated.  Corrine attributed this low rate to a variety of factors, one of which she said was many Alaskan’s lower level of access to medical care sure to isolated communities and a high number of people living off the grid.

 

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