I’m a bit torn today. On the one hand, it makes me cringe when pundits write inflammatory articles blaming Jenny McCarthy for measles outbreaks. Yes, I know that I once did the same thing myself, but, as much as antivaccinationists dislike me, I’ve actually toned it down a bit when it comes to that particular line of attack, having learned that it is important not to overstate the pro-science case or risk making errors of fact that antivaccinationists can jump all over in order to try to discredit arguments against them. On the other hand, it can’t be denied that declining vaccination rates in areas full of affluent, vaccine-averse families or where pockets of people belonging to religions that forbid vaccination or modern medicine have lead to more frequent and larger outbreaks. Even though vaccine uptake rates for most vaccine-preventable diseases remain high averaged over the nation or over individual states, the same is not true as the geographic divisions examined get smaller; i.e., as the data become more granular.
A good example of this is the ongoing measles outbreak in southern California, the one that “Dr. Bob” Sears downplayed on Facebook in a highly unprofessional rant about patients of his who were apparently calling his office, quite reasonably worried about the measles outbreak and whether they should be vaccinated. In a similarly craven “pass the buck” message, Dr. Jay Gordon basically told his patients that if they want the MMR vaccine they should get it. While another antivaccine-sympathetic pediatrician waffles about vaccines.
Then I see something like this CDC press release issued yesterday, which seriously tests my determination not to go all Orac on these people for this:
Two hundred and eighty-eight cases of measles were reported to the Centers for Disease Control and Prevention (CDC) in the United States between Jan. 1 and May 23, 2014. This is the largest number of measles cases in the United States reported in the first five months of a year since 1994. Nearly all of the measles cases this year have been associated with international travel by unvaccinated people.
“The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases. “Many of the clusters in the U.S. began following travel to the Philippines where a large outbreak has been occurring since October 2013.”
These cases come from fifteen outbreaks covering eighteen states that have been connected to travel to eighteen countries.
And, contrary to the whines by antivaccinationists that measles isn’t a dangerous disease (a truly dumb argument favored by antivaccinationists like the ones over at Age of Autism that I like to refer to as the “Brady Bunch gambit,” named after an episode of that famous sitcom in which all the Brady kids caught the measles that is often cited by antivaccinationists as an argument that 45 years ago measles wasn’t considered a big deal), this round of measles is serious, with more than one case in seven resulting in hospitalization. Complications have included five cases of pneumonia, one case of hepatitis, one case of low platelets, and one case of pancytopenia (lower counts of red and white blood cells, as well as platelets). Fortunately, no cases of encephalitis and no deaths have been reported—yet. Given that about one case of measles in twenty is complicated by pneumonia, we’ve actually been fortunate. A pneumonia rate of one in twenty should have produced nearly three times as many cases of pneumonia. In any case, given approximately one case of measles in 1,000 is complicated by encephalitis and the mortality rate is around 0.1% to 0.2%, encephalitis and deaths are inevitable if the number of measles cases continue to increase.
Personally, I can’t help but be a bit worried that the state with the most cases is Ohio, which is a mere 50 miles away. It gets even more worrisome when one notes that the season is young. Just take a look at this graph of measles cases by month compared to prior years:
The pace of increase in the number of total measles cases is far faster than any year since 1994; if the rate of increase doesn’t level off soon we might be looking at a thousand cases this year. In a few years, we might even find ourselves facing endemic levels of measles comparable to what the UK is now experiencing.
I really have to worry if history is repeating itself. Specifically, I have to wonder whether British history is going to be repeated in the US. Remember how in 2008 measles was declared endemic again in the UK, after having been declared eliminated a mere 14 years before, thanks largely to the MMR-autism scare precipitated by Andrew Wakefield’s fraudulent work? This is what the Eurosurveillance report at the time stated:
Fourteen years after the local transmission of measles was halted in the United Kingdom (UK), the disease has once again become endemic, according to the Health Protection Agency (HPA), the public health body of England and Wales. In an update on measles cases in its weekly bulletin last week, the agency stated that, as a result of almost a decade of low mumps-measles-rubella (MMR) vaccination coverage across the UK, ‘the number of children susceptible to measles is now sufficient to support the continuous spread of measles’ .
Sound familiar? It will in a minute. Take a look at the latest CDC report:
Measles elimination has been maintained in the United States since elimination was declared almost 15 years ago. However, approximately 20 million cases of measles occur each year globally, and importations into the United States continue to pose a risk for measles cases and outbreaks among unvaccinated persons. The 288 measles cases reported during January 1–May 23, 2014, including an ongoing outbreak involving 138 persons in Ohio, represent the highest number of measles cases reported for that period since 1994.
See what I mean? It took fourteen years for the UK to go from having eliminated endemic measles, thanks to the MMR vaccine, to having measles return as an endemic disease. Here we are now, around fifteen years after measles was declared eliminated in the US, and we now have the highest number of measles cases in 20 years. Now, what “eliminated” means is not that there are never cases of measles in the US. Rather, it means that there is not continuous transmission of the disease. What we’re seeing now is a series of outbreaks that have arisen from (mostly) unvaccinated people traveling abroad to countries where measles is either still endemic or there are ongoing outbreaks.
We’re not seeing continuous transmission right here in the good ol’ USA—again, yet. If vaccine rates fall enough and lead to enough areas of low vaccine uptake, that could easily change, which is why public health officials are so worried. They should be, because if outbreaks continue to occur, the disease could reach a tipping point and will once against be considered endemic. Eliminating a disease like measles, removing it from the list of endemic infectious diseases, is something that is very difficult to do. It requires a major commitment by public health officials and a high level of uptake of an effective vaccine because even the most effective vaccines (like the MMR) still have a failure rate and it is those for whom the vaccine does not provide adequate protection who can serve as the reservoir for a disease to become resurgent again. The elimination of continuous transmission of measles was a great feat; we went from a half a million cases a year to a handful, and even now there are only a few hundred. Unfortunately, those few hundred could be harbingers of a return to something resembling the bad old days because population immunity and herd immunity are difficult to achieve but don’t take very much to destroy.
You know, maybe it isn’t so over-the-top after all to “thank” Jenny McCarthy, Andrew Wakefield, “Dr. Bob” Sears, Dr. Jay Gordon, Age of Autism, Generation Rescue, Barbara Loe Fisher and the National Vaccine Information Center, The “Thinking Moms’ Revolution,” and all the panoply of antivaccine activists and groups responsible for the drumbeat of propaganda claiming that vaccines cause autism, sudden infant death syndrome (SIDS), autoimmune disease, and many other conditions that are, in fact, not caused by vaccines. Measles is on the way back, and they definitely played a role. They exaggerate the risks of vaccination, one of the safest medical interventions ever devised and arguably the one that has saved more lives than any other. In doing so, they skew the perception of the risk-benefit ratio, particularly given that vaccines have been so successful that most diseases vaccinated against are seldom seen by the parents making decisions regarding vaccinating their children. The result is decreased vaccine uptake and increased disease.
Truly, antivaccinationists, whether they admit it or not, are the pro-disease contingent.