One unvaccinated child was patient zero of a measles epidemic

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Wakefield-fraudDespite what you think is happening when you read antivaccination blogs, most people in the developed world vaccinate their children. And in the relatively undeveloped world, they are demanding more vaccines so that their children will live longer. In the USA alone, far less than 1% of children, 19-35 months, are completely unvaccinated. The problem, at least in the USA, is that those unvaccinated children tend to be clustered in small geographical areas where individuals who share the typical characteristics of many vaccine deniers tend to live.

The complication is that the herd immunity can break down rather quickly when the vaccination uptake drops below 80-90% in these clusters. And all it takes is one person carrying a vaccine preventable disease from an area, where it is endemic, to then start an outbreak or epidemic very quickly in one of these low vaccine uptake clusters. For a disease like measles, which is very contagious, it jumps from an infected person to unvaccinated individuals quite rapidly, sometimes before public health authorities can contain it. Measles is easily prevented with the MMRV vaccine (which also protects children against mumpsrubella, and chickenpox).

In a recent article published in Pediatrics, researchers investigated a measles outbreak in Minnesota in 2011. The authors, lead by Pamala Gahr of the Minnesota Department of Health, determined that the outbreak began when an unvaccinated 2-year-old travelled to Kenya, where he contracted the measles virus. Upon returning to the United States, the child developed a fever, cough and vomiting, some of the early signs and symptoms of measles. Unfortunately, prior to a diagnosis of measles, the child passed the virus on to three children in a child day-care center and another household member. The measles then spread from individual to individual within a low vaccine uptake area, a Somali immigrant community in the Minneapolis area. Eventually, more than 3,000 people were exposed to the disease.

According to the researchers, 21 cases of measles were identified. Of those, 16 individuals were not vaccinated, of whom 9 were age-eligible to be vaccinated with the MMRV (or MMR) vaccine. Of those nine children who were unvaccinated and contracted measles, seven were not vaccinated because of parental safety concerns. Gahr stated that this was consistent with a striking decline in MMR accept ache among Minnesota’s large Somali population. For example, in 2004, over 90% of Somali children in Minnesota were on schedule with the MMR vaccines. By 2010, that rate had dropped to 54%.

I want to reiterate a small point, because it keeps showing up on the zombie tropes of the antivaccination crowd. Sixteen out of the 21 individuals who contract the measles virus were not vaccinated.

Even though the number of cases was relatively small, only 21, it was the largest outbreak in Minnesota in over 20 years. What’s worse, many individuals thought that measles had been defeated in the USA (and it probably still isn’t endemic to the country).

The Somali community in Minnesota is around 20-60 thousand, with many immigrants coming to Minnesota in the 1990’s. Although the group is made up less of Somali-born individuals, and more US-born, many travel to Somalia and other nearby areas where measles is endemic. With the low vaccine uptake in this insular community, diseases contracted outside of the USA could get a toehold in this part of Minnesota. Measles is bad enough, but the situation could be worse someone brings back polio or some other vaccine preventable disease to the community.

Sadly, it appears that the thoroughly discredited nonsense from MrAndy Wakefield, who claimed that the MMR or MMRV vaccine caused autism, has taken root in the Somali community. Let’s be clear about Andy Wakefield’s lies about the MMR vaccine and autism. The Lancet, which first published Wakefield’s paper, retracted it. The British Medical Journal, a respected peer-reviewed publication, and an investigative writer, Brian Deer, wrote about Wakefield’s deceit and fraud, herehere, and here. And there are literally hundreds of peer-reviewed articles that thoroughly dismiss any link between vaccines and autism. Is this clear? If only I could convince Minnesota’s Somali community to read all of these links.

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Furthermore, I know there’s a subset of people, especially in the antivaccination cult, who are convinced that measles is not that dangerous. But it actually is quite serious, especially if it broke out and spread before public health officials could contain it. According to the US Centers for Disease Control and Prevention, the complications of measles are serious:

  • About 30% of measles cases develop one or more complications, including pneumonia, which is the complication that is most often the cause of death in young children.
  • Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
  • Diarrhea is reported in about 8% of cases.
  • These complications are more common among children under 5 years of age and adults over 20 years old.
  • As many as 1 out of every 20 children with measles gets pneumonia
  • About 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation 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, 1 or 2 will die from it.
  • Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.

Vaccine deniers constantly attempt to use anecdotes to claim “I don’t remember measles being anything more than a rash.” That’s because, unless you’re in your late 50’s, vaccinations against measles prevented most outbreaks. Yes most kids who catch measles will show no complications. But it’s the 30% who do have complications, and the 2 out of 1,000 who die, that are going to be noticed in a large outbreak. And it will be sad if it is one of your children. And remember, this disease can be transmitted to children who are too young to be vaccinated, so it can harm families who actually want to vaccinate their children. They may pay the ultimate price of a antivaccination caused epidemic.

Vaccinate your children against measles. It’s the right thing to do. Because measles shouldn’t be making a comeback in this modern world with modern medicine. It is a disease from a different time and era, something that my grandparents suffered, and not my children.

 

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The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!
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  • Joseph

    My two cents worth: Wakefield is an evil fraud, true. (That just can’t be stressed enough.) But also, but also…
    Would Wakefield have done as much damage as he did had not the news media jumped in on his “research” and spread it across multiple front pages? That’s not journalism, that’s a feeding frenzy.

    • There is blame to go around everywhere with regards to the original story. The Lancet for publishing it without the proper amount of critique. Wakefield’s hospital for making it a big media spectacle. Same for the Lancet. And no one jumping up and saying “WTF?”

  • Anti-vaxers also like to point out increased national vaccination rates (haven’t found out whether that’s a true fact or not) but they never mention that the outbreaks take place in geographical areas with low vaccine compliance. You can’t take a local phenomenon and extrapolate it to a larger populace, nor can you take national statistics and interpolate a local effect.

    • I think most of the USA ignores the anti-vaxxers, mainly because they sound like lunatics. The problem is the clusters of anti-vaxxers in small areas. That’s how an outbreak can clobber a small area.

      • Christopher Hickie

        I see more children being home schooled where I live in Arizona (nationwide the percentage is estimated at 3.4% as of 2012)–and this is a group of children that almost all states in the US can’t/won’t track vaccination rates. To attend grade or high school (other than being home schooled) in Arizona, you have to have proof of vaccination or have a waiver on file. Over the last decade, more and more children entering kindergarten in Arizona are not fully vaccinated with their parents completing the waiver form (“Personal exemptions (PBEs) are on the rise in Arizona – these rates were more than twice as high in the 2011-2012 school year(3.4%) as they were in 2003 (1.6%)”–http://www.azdhs.gov/phs/immunization/documents/statistics-reports/personal-beliefs-exemption-study/study-summary-and-recommendations.pdf).

        Now that in itself is bad enough, but AZ also does not track home schooled children’s vaccination rates. It appears, however that home schooling families are worse at vaccinating: Only 38% of homeschooling families in Pennsylvania had fully vaccinated their children, 56% had partially vaccinated and 6% completely unvaccinated–this is worrisome that ~62% of homeschooled children (in PA) are not fully vaccinated and a lot worse than for non-homeschooled children (Vaccine. 2012 Feb 1;30(6):1149-53. doi: 10.1016/j.vaccine.2011.12.019. Epub 2011 Dec 14.). Also here is an article from 2005 of a measles outbreak in Indiana that occurred primarily amongst a homeshooled population (http://www.nejm.org/doi/full/10.1056/NEJMoa060775). Also here is report on 2 cases of tetanus in homeschooled children (Vaccine-preventable disease among homeschooled children: two cases of tetanus in Oklahoma. Pediatrics. 2013 Dec;132(6):e1686-9. doi: 10.1542/peds.2013-1636. Epub 2013 Nov 11.) Also here is a good blog article on the concerns of homeschooling and vaccination rates and even simply knowing who is and isn’t vaccinated in the homeschooled community: http://www.patheos.com/blogs/lovejoyfeminism/2012/03/homeschooling-vaccinations-and-a-giant-loophole.html.

        So, in addition to more children entering kindergarten not fully vaccinated (and mostly by parental choice), we could have another ~60% of 3.5% of our children (i.e. the children who are home schooled) not fully vaccinated–and NOT being tracked for public health purposes. This is why I get angry when AV loons start foaming at the mouth and getting all “see I told you vaccines dont’ work”. No, vaccines work. But they don’t work nearly as well when your vaccination levels drop below those needed for herd immunity.

  • Christopher Hickie

    And we should not forget the 2008 San Diego County measles outbreak, which was started when an unvaccinated child traveled to Switzerland and returned to California with measles (anyone sensing a pattern here?). A total of 839 people were exposed to measles thanks to this unvaccinated patient zero. The 11 additional measles cases were ALL unvaccinated (http://www.ncbi.nlm.nih.gov/pubmed/20308208). Also, sadly noteworthy for this outbreak was the unvaccinated child who started the outbreak had previously been a patient of that wretched anti-vaccine Dr. Robert Sears (http://www.ocweekly.com/2012-08-09/news/doctor-robert-sears-vaccine-debate/full/).

    • I’m almost certain a child died in the San Diego outbreak. An unvaccinated child who caught it from another unvaccinated child. I might be confusing my detail with something else. I usually read 1-2 books a week on medicine, so occasionally I mash them together.

      • lilady R.N.

        That 2008 San Diego measles outbreak was caused by a deliberately unvaccinated child traveling to Switzerland with his family, where he became infected. He was a patient of Dr. Bob Sears and he exposed patients in two doctors’ waiting rooms and in two hospital emergency rooms. Fortunately, there were no deaths associated with the outbreak; an infant who had measles was hospitalized for several days.

        When Dr. Sears published a rant on the Huffington Post, against the passage of a California State law which would tighten up the “Personal Belief Exemption” for vaccinations, a registered nurse went after him. Dr. Sears was “upset”.

        http://scienceblogs.com/insolence/2012/03/27/dr-bob-sears-vs-seth-mnookin-measles-out/

    • No, you don’t understand – Switzerland people aren’t brown enough to be the disease scourges.

      Sorry, it just makes me so angry when the anti-vaxers take up a xenophobic position and insist that it’s all the fault of the dirty illegal immigrants. Makes me want to smash some heads.

  • Christopher Hickie

    I was a pediatrician in Tucson in 2008 when a measles outbreak occurred there. There were 14 confirmed cases that happened because one unvaccinated traveler from Switzerland came to Tucson with measles. Of note 100% of the cases were either unvaccinated or had unknown vaccination status (http://jid.oxfordjournals.org/content/203/11/1517.full.pdf). What was almost as disturbing was that 25% of the health care personnel in the two hospitals that treated these measles patients lacked evidence of measles immunity.

    • So the people who are suppose to protect us, can’t protect us. If there’s a massive outbreak, hospitals aren’t built to manage epidemics. And if the healthcare workers are getting sick, that’s going to make matters worse.

  • I wish I could type this in larger letters, and have it show up on every website for one alternating hour, every day for a month: “Andrew Wakefield is a fucking liar!”

    I loathe that asshole, and anyone that listens to him/

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  • lilady R.N.

    The measles outbreak investigation in Hennepin County (Minneapolis) was covered in the MMWR (April 8, 2011):

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a6.htm

    We also know that Wakefield made at least three trips to Minneapolis (two trips before the outbreak and one trip during the outbreak), to meet secretly with the Somali-American community to discuss his latest “theory” that Somali-American kids who receive the triple antigen MMR vaccine, are vulnerable for a diagnosis of autism:

    http://blogs.citypages.com/blotter/2011/03/andrew_wakefield_anti-vaccine_somali_measles_outbreak.php

    Wakefield is a public health menace.

    • I like covering peer-reviewed papers as they come out, especially when Pediatrics covers vaccine issues. MMWR tends to take a snapshot, then those involved go write papers, like this one, that can go beyond the MMWR take.

      Wakefield should simply be in prison. Either the UK or the US, I don’t care.

      • lilady R.N.

        I’ve been using that MMWR issue and the local newspaper articles for the past three years when I post comments on blogs.

        Andy loves publicity and I manage to provide it.

      • Lawrence McNamara

        Like Modern Day “Typhoid Mary – (though the actual story is not nearly as exciting as the fiction that has been built up around her)” Wakefield seems to bring nothing but disease in his wake…..he is a menace to public health & situations like that in MN prove it.

      • Instead, he’s immune from prosecution (wrong kind of immunity) and making money from speaking arrangements. Disgusting.