Measles Cases Linked to Disneyland Rise, and Debate Over Vaccinations Intensifies
--New York Times, January 21, 2014
Eighty-eight and counting, the number of measles cases reported so far in the 'Disneyland' outbreak, is a lot -- the largest single eruption since 2000, when the United States was declared essentially measles-free. On the other hand, eighty-eight cases aren't many, considering the population as a whole and compared to the past. Before measles vaccines became commonplace in 1963, according to CDC there were three to four million cases a year with four to five hundred of those people dying.
Measles is only part of a larger picture. Visualize the world I was a child and then parented in. Many of the vaccines available to us now, such as the one for measles, mumps and rubella (MMR), were not yet developed.
Newborns in the teaching hospital in north China where I was born in 1934 were vaccinated for smallpox before we left the hospital. And again every week until there was a 'take' -- twenty-six times in my case. The pediatrician had lost a baby to smallpox at three months because the natural immunity provided through nursing didn't last as long as the expected six months and she wasn't risking losing a baby again. In the world there, then, smallpox was rampant. Only the fortunate few babies were vaccinated.
As a five-year old I overheard Mother consoling our cook whose son in the village cut himself on something and died of lockjaw. "What's lockjaw, Mummy?" "The disease he got from the germs that got in his cut made his jaw muscles freeze so he couldn't swallow. That's why you had the tetanus shot, so you won't get it." Nonetheless, the idea was the stuff of bad dreams. Ouch! Will that scratch make me sick and my jaws lock?
Classroom exposure and childhood diseases went hand in hand. As an eight year-old, I spent a week in bed in a darkened room with a high fever and a rash -- no reading or coloring, just staring at a ceiling covered with silver wiggly-worm paper -- for fear that the measles would damage my vision.
The next year I was covered in itchy chicken pox. Still have a scar on the side of my nose to show for it. (And as an adult participated in the shingles vaccine trials that tested an antidote to the resurgence of the residual virus from having had chickenpox as a child.)
The summer of 1949 swimming pools were closed to limit a polio epidemic. We stayed out of large crowds. Pictures of children wearing leg braces or living in iron lungs filled the newspapers as well as parents' and children's nightmares.
In the late 50s and early 60s, when our babies came along, they had the standard shots of the day but those didn't protect against everything. On a day that already promised to be overfull, the first, the second, then the third of our gaggle appeared looking like chipmunks with cheeks full of nuts. Mumps. At least the boys got it before puberty when they might have become sterile.
Two years later, our then five year-old daughter came down with rubella. A friend asked if she could bring her daughter over for an 'exposure party' so she too would have it as a child. In an odd way, we were relieved. If girls eventually got rubella while they were pregnant, the fetus could be seriously deformed.
The day before all the cousins were gathering at our house for Christmas 1966, one sister-in-law called. Her brood had chicken pox. "Should we stay home?" After a quick consultation, they came. The other cousins had already had chickenpox, ours hadn't but we decided to get it over with. Two weeks later almost to the hour each of our four popped poxes. At least it didn't bounce from one to another to another over the rest of the winter.
When our children in turn were parents in the late 80s and early 90s, their children had the wider range of then routine shots. Consequently, our grandchildren only had chicken pox, just before that vaccine came into common use in 1995.
Lesson learned: Vaccinations work. The development of safe effective vaccines for such once common diseases as measles, tetanus, mumps, whooping cough, chicken pox, polio and many others topped off by the worldwide eradication of smallpox is one of the major successes of medicine. Ever.
Second lesson: Herd immunity is vital. When a critical portion of a community is immunized, even those who are not eligible for such vaccines -- infants, pregnant women or immunocompromised individuals -- are protected because the spread of contagious disease is limited. In the case of measles, this critical point is perhaps 95% of the community.
The current Disneyland outbreak is a vivid demonstration. Most of the hundreds of people who were exposed didn't get sick. They had been vaccinated. But the vast majority of those who have gotten measles had not been, including children who were too young for the shots and the kids of anti-vaxxers who chose not to vaccinate them.
Which is why the outspoken anti-vaccine movement in this country is so concerning. All it takes is one sick child to cause a serious outbreak in places like Orange County, California, parts of Oregon, or other places where 8-10% and in some private schools even 20-30% of the student body have not been vaccinated. Which threatens not only those children with potentially dangerous illnesses but, more critically, members of the community too young or too compromised to be immunized.
I wonder how many of the parents who opt not to vaccinate their children because they don't believe in them -- or even many of their doctors -- have never ever seen, much less experienced, measles and other childhood diseases. Yet, the world where the childhood diseases are not much of a threat they are raising their small children in is that way because their parents vaccinated them. And grandparents like me vaccinated their parents.
Granted, some people shouldn't be vaccinated. They are few and far between. The belief that measles vaccine causes autism, one of the drivers of the anti-vaccine movement, has been completely repudiated. But the overwhelming evidence is that for others the risk from diseases like measles far outweighs the risks of the vaccines. Those who opt out of immunization are actually depending on everyone else -- the herd -- to keep their children safe. And if enough people act this way, the herd isn't. How responsible is that? Vaccinating children is more than personal choice it is a matter of public health.
And yes, even though they need to have shots, kids don't like needles. They hurt.
So, one more lesson: When I was little we lived where we had to have a lot of shots regularly -- not only small pox, the then usual childhood inoculations and tetanus but also cholera and typhoid. My sister and I didn't like them either. To this day, I can hear my Dad patiently teaching us an important lesson. I passed it on to my children. They told theirs. Tell yours, it works: "You need to have this shot. It will keep you well. Watch the needle go in. It will sting a little. Just say ouch."
This Grandmother blog and previous ones will appear in a book to be published by Red Mountain Press next year.