EDITORIAL ON MEASLES VACCINE, PROF. MARC SIEGEL, NEW YORK UNIVERSITY

Tuesday, 27th of January 2015

EDITORIAL ON MEASLES VACCINE, PROF. MARC SIEGEL, NEW YORK UNIVERSITY

Fear Measles, Not Vaccines

The outbreak traced to Disneyland visitors reflects a dangerous parenting trend.

By Marc Siegel

Wall Street Journal, Jan. 26, 2015 6:43 p.m. ET

A measles outbreak traced to the Disneyland theme park in California has infected nearly 70 people since December. Even before this alarming episode, 2014 saw the worst U.S. measles outbreak in two decades. What else happened last year? More than 13,000 parents nationwide claimed on forms that vaccinating their children from preventable diseases like measles violated their “personal beliefs.”

Most of these parents are motivated by irrational fears. It is human to be nervous about injecting foreign substances into the body of a child, but should parents be more afraid of the vaccine or the virus? With measles, there is no question: The virus is the danger.

Before 1963, when the measles vaccine became available for public use in the U.S., there were more than 500,000 reported measles cases every year, according to Centers for Disease Control and Prevention data. On average, 432 cases a year resulted in death. After an effective vaccination campaign, that number dwindled to 86 measles cases by 2000, with zero fatalities.

Now the disease has returned—with some 640 cases last year—thanks in large part to parental anxiety about vaccination. It is no coincidence that outbreaks happen in communities with low vaccination rates. Nor is it surprising that outbreaks happen at places like Disneyland, where people are pressed together in crowds. Measles is a highly contagious disease with an attack rate of 90%, meaning that an infected person has a 90% chance of spreading it to someone else in close contact. Compare that with the flu, which the public considers highly contagious yet has an attack rate of 25%.

Measles travels on small respiratory droplets, and it takes a week or two for an infected person to develop symptoms. The early symptoms of fatigue, muscle aches and high fever are mostly indistinguishable from the flu, so measles carriers can easily spread the illness before they know they have it. A physician must look for red, watery eyes, white spots on the inner cheeks and a telltale rash that appears a few days after infection.

Measles is tolerated well in most people, but it can be devastating to others. As many as one in 20 children develop pneumonia, and more than one in 10 suffer an ear infection. Even worse, a brain infection known as encephalitis occurs in one or two per 1,000 infections; that is also about the death rate from measles. The frequency of complications and the extreme contagiousness are why public-health officials are terrified of a measles comeback.

Parents should be afraid, too. But too many are more fearful of a highly effective vaccine that provides nearly 99% immunity after two doses. In the past decade, a misinformed campaign by parents and even some doctors has apparently succeeded, to a degree, in demonizing the measles, mumps and rubella (MMR) vaccine. The critics relied heavily on a 1998 British study supposedly linking the MMR vaccine and autism. The study has been completely discredited, but its pernicious effect continues. Only about half of Americans believe that vaccines are safe and effective, according to a 2014 poll by the Associated Press and GfK Public Affairs.

The medical risk from the MMR vaccine is minuscule compared with the potential complications from measles. The Vaccine Adverse Events Reporting System has received reports of about 6,000 serious side effects following administration of the MMR vaccine since 1990, with 288 associated deaths. Compare that with the nearly 10 million doses of the MMR vaccine given every year, according to the CDC. A 2007 British study published in the journal Pediatrics found the risk of serious neurological disease following administration of the first dose of the MMR vaccine to be one in 365,000 doses. Remember: The risk of brain inflammation from measles is one or two in just 1,000.

Medicine involves cost-benefit analysis, and it is clear that the benefits of the MMR vaccine far exceed the costs. The bottom line: Not vaccinating children invites a measles resurgence.

In the recent outbreak traced to Disneyland, infants less than a year old are most at risk because they arent old enough to have received the first MMR dose. Also at risk are the 10% of the children who have gotten the vaccine but it has worn off, something that can happen over time since immune systems arent completely predictable. Then there are children with chronic diseases, who are at risk because they cant be vaccinated. And while the vaccine is extremely effective, it is not perfect: A handful of the confirmed Disneyland cases were children who had received the vaccine.

I had measles as a young child and I am glad that Ive never had to treat it in my career as a physician. That may change soon if vaccination rates continue to drop. The unwarranted fear is an assault on one of the greatest public-health inventions in world history.

Dr. Siegel is a professor of medicine at NYU Langone Medical Center. He is the author of “False Alarm: The Truth About the Epidemic of Fear” ( Wiley, 2006) and a Fox News medical correspondent.