Measles victory has been reversed

[Guest guest]

An early cure for parents' vaccine panic

By Seth Mnookin, Published: June 10

Almost exactly 15 years ago, top officials of the World Health Organization and

the Centers for Disease Control and Prevention met in Atlanta to strategize for

what would have been one of the most remarkable public health victories in

history: the eradication of measles, one of the most infectious microbes known

to humankind. By the mid-1990s, widespread use of the measles vaccine had halted

transmission of the virus among residents of the United States and Britain. A

CDC report noted that the major obstacle to eradication was that public and

political support would wane as fears of the disease receded. There was no

mention of parental concern that the measles vaccine might actually be harmful.

Today, that fear — specifically, a misplaced anxiety that the measles component

of the measles-mumps-rubella (MMR) vaccine could cause autism — has become one

of the main impediments to stopping the spread of the disease in North America

and Western Europe. Last month, the CDC announced that 118 measles infections

were reported in the United States in the first 19 weeks of the year. It doesn't

sound like a lot, but it represents a worrisome uptick, and it puts us on track

to hit 300 cases in 2011, compared with an average of around 50 from 2001

through 2008.

Outbreaks have ranged from the Northeast to the Pacific Northwest, from the Gulf

Coast to Southern California. Because of how easily measles can spread, attempts

to contain even a single case can require enormous effort: On Wednesday, the

land Department of Health and Mental Hygiene announced that it was

investigating whether a lone traveler to the state had exposed people to the

disease at a grocery store, a liquor store, a high school graduation ceremony,

an Applebee's and a Baltimore Orioles game.

Since the autism-MMR canard was introduced by a British doctor named

Wakefield in 1998, there have been dozens of studies by scientists around the

world showing that it does not have any validity. But once fear is injected into

a population, it can be difficult to eradicate, and some parents are still

choosing to delay some vaccines and skip others altogether. For example, between

2005 and 2010, the rates of unvaccinated children doubled in New York and

Connecticut and a recent investigation found 200 schools in southern California

at risk for outbreaks because of the number of parents who were choosing not to

immunize. That the concern about a possible autism-vaccine connection remains so

pervasive makes clear that the efforts to combat this misinformation have been

inadequate. We need to fix the way we teach parents about vaccinations — and one

way to do that is to start before they actually become parents.

Three years ago, I began work on my book " The Panic Virus, " about the recent

controversies regarding vaccines and autism. If there's one thing I've learned,

it's that virtually everyone involved in this issue is frustrated. Pediatricians

are exasperated at the amount of energy they spend addressing specious concerns,

public health officials are discouraged by the rise of vaccine-preventable

infectious diseases, and families who believe that their children were injured

by vaccines feel forsaken by their doctors and their government.

But the most important players in this drama are expectant parents and parents

of very young children. In many ways, they have the most legitimate reason to

complain about the way they're being treated. A recent survey found that 60

percent of parents actively sought out information about vaccine safety before

their children were vaccinated, but typically the first time the topic comes up

with a medical professional is when there is a needle in their pediatrician's

hands. The first several months of a baby's life are overwhelming, exhausting

and nerve-racking — not exactly the best time to process a lot of new

information.

I know: Just as I was finishing work on the book, my wife gave birth to our

first child. Throughout her pregnancy, we kept meticulous notes about every

conversation we had with our health-care providers. We knew the difference

between nuchal translucency screening and amniocentesis, and we knew the

relative risks of various procedures, both nationwide and at the hospital we

were using.

No such notes exist for the period after our son was born. By the time we showed

up for his two-month checkup, I barely had enough energy to brush my teeth. That

was when, in the midst of a 15-minute " wellness " appointment, our son was

scheduled to receive vaccines that would protect him against rotavirus,

pneumococcal disease, diphtheria, tetanus, pertussis, Haemophilus influenzae

type b, polio and hepatitis B. It's true that there were signs in our

pediatricians' office stressing the importance of vaccines — but at no point did

anyone broach the topic or offer to answer any concerns.

If, on the other hand, we had had a scheduled appointment before our son was

born to discuss issues of infant health — such as the dangers of infectious

diseases and the importance of vaccines — we would have written that information

down and reviewed it when we got home. If we'd had questions, we could have

discussed them at a time when we were able to actually process the answers.

At a prenatal appointment, with no baby to distract or soothe, parents could ask

how vaccines work. They could digest the fact that, contrary to some rumors,

vaccines are not injected directly into the bloodstream, they do not contain

antifreeze, and there is no evidence that children receive " too many too soon. "

They could discuss early warning signs for developmental disabilities and review

the studies showing that there is no connection between vaccines and autism.

They could hear about the dozens of infants who have recently been hospitalized

with measles or have died of whooping cough. And they could learn about " herd

immunity " — what occurs when enough people in a population are immune to a

disease to prohibit it from being spread in the first place.

There are logistical hurdles to setting up this type of system, including the

fact that for the most part, the obstetricians who treat pregnant women are not

trained in pediatric care. But squabbling over treatment turf instead of looking

for new ways to tackle the problem is short-sighted.

As we've been discovering, the costs of getting vaccine education wrong are

potentially enormous. It's too early to tabulate the costs of this year's

outbreaks, but recent studies have looked at two small-scale outbreaks in early

2008: one in Tucson in which 14 people were infected and one in San Diego in

which 12children were infected. (All of those cases occurred in unvaccinated

children or adults of unknown vaccine status.) Arizona's outbreak ended up

costing $800,000 to contain, and San Diego's $200,000, figures that were

obtained by adding up hospital and quarantine costs, among other expenses.

As recent history has shown, these figures can explode in an incredibly short

time. In 2006 and 2007, France had an average of 40 measles cases per year. In

the first five months of 2011, the country has recorded more than 10,000

infections, including 360 cases of severe measles pneumonia, 12 cases of

encephalitis and six deaths. In 2008, Britain declared that the number of

unvaccinated children was large enough to sustain the " continuous spread " of the

disease — which means the victory that was celebrated 15 years earlier had

essentially been reversed.

We have not yet reached that point in the United States. And talking about

vaccines before a baby is born might be all it takes to ensure we never do.

Seth Mnookin , a lecturer in MIT's Graduate Program in Science Writing, is the

author of " The Panic Virus: A True Story of Medicine, Science, and Fear. "

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