Within the past 5 years the growth of various anti-vaccination movements have caused public discussion and worry about the topic of vaccination. In a recent CDC nationwide survey, the amount of kindergarteners with all applicable vaccines varied state by state with coverage as low as 84% in some states to coverage over 99% in other states (with 26 states reporting that they have not met the federally recommended targets of 95% coverage). The recent measles outbreaks across the nation have brought the subject of vaccine avoidance to national discussion.
Measles within the United States – A Brief History
The measles vaccine program was initiated in 1963 nationwide. Before the program began, an estimated 3 million people contracted measles annually. Of that number, over 400 died, over 48,000 were hospitalized, and over 4,000 developed encephalitis from the measles illness. In 2000, the CDC declared that Measles had been eliminated within the United States. In 2014, the United States experienced 23 separate measles outbreaks for a combined total of over 600 cases (383 of these cases occurred among unvaccinated communities in Ohio).
Worldwide, measles is still extremely common and is often devastating among unvaccinated populations. An estimated 20 million people contract measles each year and 146,000 people die annually from the disease (approximately 17 people an hour).
As of February 6th, 2015 the CDC reports that the United States is currently experiencing a large multi-state outbreak has resulted in 120 cases and is believed to be linked to an amusement park in California. An individual source has not yet been identified, however the virus is identical to the virus type that caused a large international measles outbreak in the Philippines in 2014.
Measles is one of the most highly contagious diseases in the world. It lives in the throat and nose mucus of infected people and can be spread through coughing and sneezing. Measles can live for up to two hours on a surface or in the airspace in which an infected person sneezed or coughed. It is estimated that 90% of the people who are close to and come into contact with an infected person will contract measles unless otherwise immune to the disease.
The majority of adults living in the developed world are vaccinated (Measles-Mumps-Rubella “MMR vaccine” or Measles-Mumps-Rubella-Varicella “MMRV vaccine”). It is estimated that one dose of a measles vaccine is 93% effective at preventing measles (this number rises to 97% after two doses). Accordingly, 3% of all vaccinated individuals are not able to prevent infection (however, infection among these individuals is significantly milder).
A Note on Vaccine Safety:
The majority of required childhood vaccines no longer contain Thimerosal (a mercury-containing preservative) or mercury. Since the early 2000’s, policymakers, vaccine manufacturers, and public health care agencies have pushed for the removal or reduction of mercury use within vaccines. The exemptions include: the influenza vaccine, Japanese encephalitis, tetanus toxoid, and meningococcal.
Many individuals have made public claims regarding the links between vaccination (specifically measles) and the onset of autism. This belief stemmed from a 1998 study published by a British physician examining a potential link between autism and the measles virus. Subsequent clinical trials did not reproduce the findings of the original study and could not establish a connection between autism and the measles virus. Following a wave of controversy, the journal eventually discredited the findings, 10 of the 13 original authors retracted their names from the article, and the physician’s medical license was removed and he was tried for professional misconduct. Recent studies confirm that there is no link between measles and autism. The largest of these studies was published in the New England Journal of Medicine and involved a review of over 500,000 children and resulted in no association being found between measles vaccination and autism onset.
Although, all current evidence and clinical data illustrates the safety of national public vaccination programs, the now statistically significant groups that oppose this viewpoint will help to bring forth a national discussion on vaccination. It is likely that this issue will cause considerable conflict between parents of vaccinated children, parents of non-vaccinated children, and the public areas in which their children may be forced to interact. For health care providers, the growing threat of malaria cases will bring forth new challenges in regards to the safe management of at risk hospital populations.