Jan. 29, 2015 (San Diego) We are up to 96 confirmed measles cases. This outbreak continues to grow. Federal Authorities now believe it either came to the happiest place on earth via a tourist, or an American who caught it abroad. The disease is no longer considered endemic in the United States.
So what now? We now have two different school districts where parents who refuse to vaccinate their kids have been told, stay home. Is this a solid public health tactic? Yes. These children, who are not vaccinated, are not just themselves at greater risk, 35 percent, of getting sick. They also put others at greater risk as well.
By others I mean children who are 12 months or younger. These babies cannot be vaccinated, since the immune systems are not developed and the vaccine will not take. What will take is a good case of the measles, and these babies are also at a higher risk for complications from the disease. Measles is highly contagious and very easy to spread in unvaccinated populations.
Others who are at risk are children who are of school age, who cannot be vaccinated because they have immune systems that are compromised. These are children who have things like Leukemia, other forms of Cancer, or AIDS. They cannot be vaccinated and rely on children who are medically fit to be vaccinated to provide what is called herd immunity. Those children who are medically fit are the majority of children.
This morning there was talk of lawsuits. I have no idea if a lawsuit will even be given standing in US Courts if a child with a compromised immune system gets sick, or worst dies from the disease. This is truly untested legal ground. Given the nature of our litigious society, I would not dismiss this though.
At the moment we have some impressive statistic. Among them, Arizona is keeping tabs on 1000 people who may have come in contact with a measles patient. We are also getting an increasing number of cases and young doctors and nurses are looking at what does this look like? Why? Most young practitioners have not seen a case of measles in their professional careers.
This is the kind of thing you read in a textbook. So they are not looking for tell tale white dots inside mouths when a child (or adult) presents with what looks like a serious case of the flu, or other upper respiratory syndrome. These dots come earlier than the tell tale rash.
When a doctor sees a child who cannot stand the light, and is all achy, and not in a good mood, this is not likely to trigger the word measles with most providers. This is something you see in textbooks and senior doctors know about, even grand mothers. This experience to be able to recognize the disease is simply missing in young medical providers.
So how serious is disease? Well, via de Centers for Disease Control we learn this:
Common measles complications include ear infections and diarrhea.
Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
Diarrhea is reported in less than one out of 10 people with measles.
Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.
As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or mentally retarded.
For every 1,000 children who get measles, one or two will die from it.
This is not a mild disease. So what about Autism? The British study that originally pushed this has been discredited. No subsequent studies have found the vaccine to pose a risk at all.
Now there is a new problem arising with the anti vax movement. I guess autism is not selling. Apparently if you get vaccinated, you will get the disease. As a historian this has a definite echo, to the 18th and 19th century, when Edward Jenner made an incredible observation. Women, and it was mostly women, who milked cows, and had open sores, at times got cow pox. He noticed that these women did not get the more serious, and deadly, small pox.
So he decided to experiment and out of his experiments came the first successful vaccine. Don’t get me wrong, the procedure was messy, and would not pass muster with our current medical system. Then again in 1796 we had nothing close to modern germ theory, and his experiments led ultimately to the eradication of small pox. This is no small feat.
The Church though was hardly impressed and they feared this inoculation. The Church spread the idea that you could get the disease, small pox, from the inoculations. So when I hear people saying this about Measles and the vaccine, that it can spread the disease, I am quite brutally honest gobsmacked.
So we are to the point where public health authorities will have to decide. During this crisis, at the very least, do they let non vaccinated, with personal exception letters, children attend school? So far Huntington Beach, one school district near Palm Springs have said no.
At the same time a parent of a child with Leukemia, who has a medical exception, has asked the school district in Northern California to keep unvaccinated children with non medical exceptions away. The Superintendent of Marin County said he cannot do that.
Meanwhile some doctors are now refusing to see children who’s parents refuse to vaccinate. This is also a small, but growing movement among health care providers. While it has been developing for some years, now it is picking speed. This raises issues of bio-ethics, since providers should do no harm, but keeping children who’s parents refuse to vaccinate in their practice, might do harm to other children.
As this outbreak continues to run its course, we will see more of this. The discussion is just starting. It is also clear that the pockets where these parents live, tend to be wealthier, and well educated. This is a paradox of the movement, but perhaps, we have been victims of our own success. Parents no longer fear measles. They have not seen it. They fear other things, such as autism.
Parents want to do the best for their children, we all understand this. Consequences though are now under consideration by larger segments of society. Measles is no longer endemic in the United States. The larger social interest is to keep it that way.
Incidentally, the state of Sonora, Mexico has issued a health travel warning to the states of California, Arizona, Washington and Utah. Their last case of measles was in 1995 and they would like to keep it that way.
This is also a consequence of the current outbreak. They are also recommending that people who decide to travel in spite of the warning, receive a vaccine 15 days before the trip.
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