The danger of measles

First the good news: According to a study commissioned by the Centers for Disease Control and Prevention and published in JAMA Pediatrics on Dec. 5, measles was officially eliminated in the United States in 2000, and that elimination persisted until 2011. This shows that the vaccine, first approved in 1963, has been effective at "eliminating" the disease, defined as the absence of endemic disease transmission.

This is no small feat. Measles is highly contagious, and prior to 1963, resulted in about 500 deaths per year in the United States, and tens of thousands of hospitalizations. Because it’s so highly contagious, vaccinating a large chunk of susceptible patients was the only way to effectively combat the disease. The "elimination" of the disease marks the success of vaccination strategies. Globally, there are now 500,000 fewer deaths per year from measles than there were a decade ago. If we continue with vaccination programs as we do, there is a chance we can eradicate the disease (JAMA Pediatrics 2013 [doi:10.1001/jamapediatrics.2013.4342]).

Now the bad news: This year, according to a statement that the CDC put out on Dec. 5, there have been 175 cases of measles. This is three times the annual median number of about 60. These cases have been concentrated in communities that are against vaccination, usually brought in from other places where antivaccination sentiments are also high, like Europe, or where vaccination strategies are lagging, like the developing world.

In a well-publicized outbreak in Texas in August, 21 unvaccinated people belonging to the Eagle Mountain International Church contracted the disease when an unvaccinated man travelled to Indonesia and came back ill. The pastor, Terri Copeland Pearsons, daughter of a televangelist Kenneth Copeland, clarifies that she is not against vaccinations but she has reservations about them. "The concerns we have had are primarily with very young children who have family history of autism and with bundling too many immunizations at one time."

Ms. Pearsons further says: "the facts are the facts, but then we know the truth. That always overcomes facts." When did fact become the enemy? How does faith trump science? Why do people treat science with such skepticism, and yet take anecdotes as gospel truth? How is it that despite the best efforts of infectious disease and pediatric societies to dispel such mistaken notions, these ideas survive?

In studies exploring the psychology of vaccine refusal, the factors that parents take into consideration include, but are not limited to, the perceptions of vulnerability of the children, severity of the disease, and safety of the vaccine.

People have forgotten just how severe measles can be. In addition, the unfounded belief that the vaccine can cause autism has just taken on a life of its own, given credibility by celebrities.

I understand that for some people anecdotes often tell a more powerful story than data does. So here’s one anecdote from the personal anecdote library of a doctor from a developing country.

I knew Albert through mutual friends. He played bass in a rock band, belonged to a fraternity in medical school, was involved in intramural basketball, and was in a loving relationship. By the time we graduated from medical school, he was the proud father of a baby girl.

But then things seemed to fall out of place. He failed the medical boards. He uncharacteristically sank into a deep depression that was so severe that he required inpatient treatment, and even then the treatments were not working. Still the assumption was that he had depression from his life’s circumstances.

And then he had a seizure.

That was when the diagnosis of subacute sclerosing panencephalitis, or SSPE, was made. It explained the personality change, intellectual difficulty, and seizures. He had contracted measles 10 years earlier, and this is a known complication of measles, one that hospitals in the Philippines are unfortunately all too familiar with. He died within a few weeks of diagnosis.

Society has forgotten how severe measles can be. We have an effective vaccine and effective global vaccination programs. We therefore have a chance to eradicate this disease altogether, like we did with smallpox and like we’re trying to do with polio. One parent’s strongly held but erroneous beliefs can cause trouble for large segments of the population. Ignoring the antivaccination rhetoric won’t make it go away.

Dr. Chan practices rheumatology in Pawtucket, R.I.

First the good news: According to a study commissioned by the Centers for Disease Control and Prevention and published in JAMA Pediatrics on Dec. 5, measles was officially eliminated in the United States in 2000, and that elimination persisted until 2011. This shows that the vaccine, first approved in 1963, has been effective at "eliminating" the disease, defined as the absence of endemic disease transmission.

This is no small feat. Measles is highly contagious, and prior to 1963, resulted in about 500 deaths per year in the United States, and tens of thousands of hospitalizations. Because it’s so highly contagious, vaccinating a large chunk of susceptible patients was the only way to effectively combat the disease. The "elimination" of the disease marks the success of vaccination strategies. Globally, there are now 500,000 fewer deaths per year from measles than there were a decade ago. If we continue with vaccination programs as we do, there is a chance we can eradicate the disease (JAMA Pediatrics 2013 [doi:10.1001/jamapediatrics.2013.4342]).

Now the bad news: This year, according to a statement that the CDC put out on Dec. 5, there have been 175 cases of measles. This is three times the annual median number of about 60. These cases have been concentrated in communities that are against vaccination, usually brought in from other places where antivaccination sentiments are also high, like Europe, or where vaccination strategies are lagging, like the developing world.

In a well-publicized outbreak in Texas in August, 21 unvaccinated people belonging to the Eagle Mountain International Church contracted the disease when an unvaccinated man travelled to Indonesia and came back ill. The pastor, Terri Copeland Pearsons, daughter of a televangelist Kenneth Copeland, clarifies that she is not against vaccinations but she has reservations about them. "The concerns we have had are primarily with very young children who have family history of autism and with bundling too many immunizations at one time."

Ms. Pearsons further says: "the facts are the facts, but then we know the truth. That always overcomes facts." When did fact become the enemy? How does faith trump science? Why do people treat science with such skepticism, and yet take anecdotes as gospel truth? How is it that despite the best efforts of infectious disease and pediatric societies to dispel such mistaken notions, these ideas survive?

In studies exploring the psychology of vaccine refusal, the factors that parents take into consideration include, but are not limited to, the perceptions of vulnerability of the children, severity of the disease, and safety of the vaccine.

People have forgotten just how severe measles can be. In addition, the unfounded belief that the vaccine can cause autism has just taken on a life of its own, given credibility by celebrities.

I understand that for some people anecdotes often tell a more powerful story than data does. So here’s one anecdote from the personal anecdote library of a doctor from a developing country.

I knew Albert through mutual friends. He played bass in a rock band, belonged to a fraternity in medical school, was involved in intramural basketball, and was in a loving relationship. By the time we graduated from medical school, he was the proud father of a baby girl.

But then things seemed to fall out of place. He failed the medical boards. He uncharacteristically sank into a deep depression that was so severe that he required inpatient treatment, and even then the treatments were not working. Still the assumption was that he had depression from his life’s circumstances.

And then he had a seizure.

That was when the diagnosis of subacute sclerosing panencephalitis, or SSPE, was made. It explained the personality change, intellectual difficulty, and seizures. He had contracted measles 10 years earlier, and this is a known complication of measles, one that hospitals in the Philippines are unfortunately all too familiar with. He died within a few weeks of diagnosis.

Society has forgotten how severe measles can be. We have an effective vaccine and effective global vaccination programs. We therefore have a chance to eradicate this disease altogether, like we did with smallpox and like we’re trying to do with polio. One parent’s strongly held but erroneous beliefs can cause trouble for large segments of the population. Ignoring the antivaccination rhetoric won’t make it go away.

Dr. Chan practices rheumatology in Pawtucket, R.I.

First the good news: According to a study commissioned by the Centers for Disease Control and Prevention and published in JAMA Pediatrics on Dec. 5, measles was officially eliminated in the United States in 2000, and that elimination persisted until 2011. This shows that the vaccine, first approved in 1963, has been effective at "eliminating" the disease, defined as the absence of endemic disease transmission.

This is no small feat. Measles is highly contagious, and prior to 1963, resulted in about 500 deaths per year in the United States, and tens of thousands of hospitalizations. Because it’s so highly contagious, vaccinating a large chunk of susceptible patients was the only way to effectively combat the disease. The "elimination" of the disease marks the success of vaccination strategies. Globally, there are now 500,000 fewer deaths per year from measles than there were a decade ago. If we continue with vaccination programs as we do, there is a chance we can eradicate the disease (JAMA Pediatrics 2013 [doi:10.1001/jamapediatrics.2013.4342]).

Now the bad news: This year, according to a statement that the CDC put out on Dec. 5, there have been 175 cases of measles. This is three times the annual median number of about 60. These cases have been concentrated in communities that are against vaccination, usually brought in from other places where antivaccination sentiments are also high, like Europe, or where vaccination strategies are lagging, like the developing world.

In a well-publicized outbreak in Texas in August, 21 unvaccinated people belonging to the Eagle Mountain International Church contracted the disease when an unvaccinated man travelled to Indonesia and came back ill. The pastor, Terri Copeland Pearsons, daughter of a televangelist Kenneth Copeland, clarifies that she is not against vaccinations but she has reservations about them. "The concerns we have had are primarily with very young children who have family history of autism and with bundling too many immunizations at one time."

Ms. Pearsons further says: "the facts are the facts, but then we know the truth. That always overcomes facts." When did fact become the enemy? How does faith trump science? Why do people treat science with such skepticism, and yet take anecdotes as gospel truth? How is it that despite the best efforts of infectious disease and pediatric societies to dispel such mistaken notions, these ideas survive?

In studies exploring the psychology of vaccine refusal, the factors that parents take into consideration include, but are not limited to, the perceptions of vulnerability of the children, severity of the disease, and safety of the vaccine.

People have forgotten just how severe measles can be. In addition, the unfounded belief that the vaccine can cause autism has just taken on a life of its own, given credibility by celebrities.

I understand that for some people anecdotes often tell a more powerful story than data does. So here’s one anecdote from the personal anecdote library of a doctor from a developing country.

I knew Albert through mutual friends. He played bass in a rock band, belonged to a fraternity in medical school, was involved in intramural basketball, and was in a loving relationship. By the time we graduated from medical school, he was the proud father of a baby girl.

But then things seemed to fall out of place. He failed the medical boards. He uncharacteristically sank into a deep depression that was so severe that he required inpatient treatment, and even then the treatments were not working. Still the assumption was that he had depression from his life’s circumstances.

And then he had a seizure.

That was when the diagnosis of subacute sclerosing panencephalitis, or SSPE, was made. It explained the personality change, intellectual difficulty, and seizures. He had contracted measles 10 years earlier, and this is a known complication of measles, one that hospitals in the Philippines are unfortunately all too familiar with. He died within a few weeks of diagnosis.

Society has forgotten how severe measles can be. We have an effective vaccine and effective global vaccination programs. We therefore have a chance to eradicate this disease altogether, like we did with smallpox and like we’re trying to do with polio. One parent’s strongly held but erroneous beliefs can cause trouble for large segments of the population. Ignoring the antivaccination rhetoric won’t make it go away.

Dr. Chan practices rheumatology in Pawtucket, R.I.