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Antivaccinationist activism versus measles in the U.S.: Are the chickens coming home to roost?

Over the last few years, depressingly, we’ve witnessed a rise in antivaccinationist activism. Beginning with the highly unethical activities of Andrew Wakefield and his bogus study in 1998 that set off a scare over the MMR vaccine supposedly causing autism that led to declining vaccination rates and skyrocketing measles and mumps rates in the U.K., it metastasized to the U.S. with hyped up concerns that the mercury-containing preservative thimerosal used in most vaccines until 2001 was a cause of autism. Over the last year or so, it’s been helped along by useful celebrity idiots like Jenny McCarthy who, while oh-so-seriously assuring everyone that she really, truly is “not antivaccine,” goes around the country spouting off every canard in the antivaccination playbook (some so stupid that it’s hard to believe anyone can believe them) and the media’s inability to understand that the Hannah Poling case was not a government concession that vaccines cause autism.

Even more depressingly it may well be having an effect in terms of decreased vaccination rates, and now the chickens may be coming home to roost. According to the CDC:

Measles, a highly contagious acute viral disease, can result in serious complications and death. As a result of a successful U.S. vaccination program, measles elimination (i.e., interruption of endemic measles transmission) was declared in the United States in 2000 (1). The number of reported measles cases has declined from 763,094 in 1958 to fewer than 150 cases reported per year since 1997 (1). During 2000–2007,* a total of 29–116 measles cases (mean: 62, median: 56) were reported annually. However, during January 1–April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported to CDC, the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.

Antivaccinationists, of course, will likely just say, “So what? Measles isn’t dangerous. The MMR is more dangerous than measles.”

Wrong, wrong, wrong, wrong:

Before introduction of measles vaccination in 1963, approximately 3 to 4 million persons had measles annually in the United States; approximately 400–500 died, 48,000 were hospitalized, and 1,000 developed chronic disability from measles encephalitis (1). Even after elimination of endemic transmission in 2000, imported measles has continued to create a substantial U.S. public health burden; of the 501 measles cases reported during 2000–2007, one in four patients was hospitalized, and one in 250 died (1).


These cases remind us that it is important to vaccinate children and adults to protect them against measles. Even though the ongoing transmission of measles was declared eliminated in the U.S. in 2000, the disease is still common in other parts of the world and can be imported into the U.S. from many countries, including countries in Europe. Worldwide, 20 million cases of measles still occur each year, and the disease is a significant cause of vaccine-preventable death among children. In 2005, 311,000 children under age 5 died from the disease.

But, hey, those 311,000 weren’t Americans; so I guess they don’t matter, right? Never mind that according to the World Health Organization, measles is a leading cause of preventable childhood mortality. In any case, just because the vast majority of those who contract the measles survive it without long term complications doesn’t mean that for a significant minority it isn’t a deadly disease that can kill or cause serious permanent neurological sequalae. Just because The Brady Bunch did an episode where the Bradys contracted measles is not, as the Age of Autism in a statement of the highest level of neuron-apoptosing stupidity claims, reason to conclude that measles must not have been a major killer. (Hard as it may be to believe, the comments after the AoA post to which I linked are even more idiotic. They’re not just stupid; they’re scary stupid.) Worse, antivaccinationists tend to cluster, making it easier for the disease to be established and spread:

Many of the measles cases in children in 2008 have occurred among children whose parents claimed exemption from vaccination because of religious or personal beliefs and in infants too young to be vaccinated. Forty-eight states currently allow religious exemptions to school vaccination requirements, and 21 states allow exemptions based on personal beliefs.*** During 2002 and 2003, nonmedical exemption rates were higher in states that easily granted exemptions than states with medium or difficult exemption processes (7); in such states, the process of claiming a nonmedical exemption might require less effort than fulfilling vaccination requirements (8).

Although national vaccination levels are high, unvaccinated children tend to be clustered geographically or socially, increasing their risk for outbreaks (6,9). An upward trend in the mean proportion of school children who were not vaccinated because of personal belief exemptions was observed from 1991 to 2004 (7). Increases in the proportion of persons declining vaccination for themselves or their children might lead to large-scale outbreaks in the United States, such as those that have occurred in other countries (e.g., United Kingdom and Netherlands) (10).

Also, let’s not forget that no vaccine is 100% effective. People who have had the MMR but failed to develop immunity or who can’t be vaccinated for medical reasons depend on herd immunity. When the vaccination rate falls below a certain critical threshold (it is argued whether that threshold is around 90% or perhaps higher, but it’s probably different for different diseases and vaccines), the unvaccinated form a pool that can facilitate the spread of disease even in a population with a relatively high vaccination rate. In other words, antivaccinationists, by refusing to vaccinate, take advantage of herd immunity (at least while it lasts), while endangering the population among which they live. There’s a reason why vaccinations are required before school; unfortunately, states are prone to making religious and philosophical exemptions easier to get. Meanwhile pediatricians are under siege by parents frightened by this garbage.

One group of pediatricians, however, are taking a stand. All-Star Peditricians have issued a vaccine policy statement. They even take a stand:

Finally, if you should absolutely refuse to vaccinate your child despite all our efforts, we will ask you to find another health care provider who shares your views. We do not keep a list of such providers, nor would be recommend any such physician. Please recognize that by not vaccinating you are putting your child at unnecessary risk for life threatening illness and disability, and even death.

If only more pediatricians, group practices, and children’s hospitals would have the cojones to have a similar policy. Dr. Gordon, are you listening?

ADDENDUM: DrugMonkey agrees.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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