704. At the time of this writing there have been 704 cases of measles reported in the United States, with two of those cases recently occurring in northeast Iowa. Why is a disease that was declared eradicated from the Americas in 2000 making a comeback and what are the implications?
We don’t have to look very far to see how a vaccine-preventable disease can devastate our city. An iron lung from Sioux City’s St. Vincent’s hospital sits in our Sioux City Public Museum. A widespread polio outbreak in the area from flooding and sewage backup resulted in 952 polio cases and 53 associated deaths.
Most of us will never experience measles on a personal level. We won’t have to console a crying baby covered in rash with high fever, bloodshot eyes and sore throat, hoping against hope that this baby won’t become a statistic, knowing that there is no treatment, only prevention, for the illness which can lead to pneumonia, encephalitis and death. Those born before the arrival of the measles vaccine may report having measles with varying degrees of symptoms from mild illness to serious illness. In those stories we may find reassurance or cause for concern based on our pre-existing beliefs about vaccines. As with all personal stories involving disease, they are subject to survivor’s bias. Those that succumbed to the disease are not left to tell their story. It’s up to the rest of us to carry their stories and shout it from the rooftops, if necessary, to prevent what happened in the past from occurring again.
In those decades where the disease faded from memory, new stories filled the void, carried in some cases by hucksters selling a new brand of snake oil. Who and what do we believe in an era where to be anti-establishment is to be informed and social media allows for rapid spread of misinformation? When it comes to our health and well-being, we must return some of our trust to entities that are built around a scientific method of data collection, observation, and study, and be skeptical of those that promise us rapid cures built on pyramid schemes and unproven claims.
Prevention of measles, in the form of a vaccine, is very good, but not perfect in its protection. It does not perfectly protect everyone, and measles is so contagious that unless at least 90 to 95 percent of a population is immunized against measles they are susceptible to large outbreaks.
As misinformation spreads about vaccines and more people choose to avoid immunization, they become tinder for an outbreak, and all those who either were too young for immunization or who didn’t develop full immunity from the vaccine become the kindling. All we need is a spark from international travel to measles-affected areas and then we find ourselves in 2019 where, to date, we have 704 measles cases in the United States, the most so far this century.
The most vulnerable of us - the young, the old, the ill - will suffer the most, but there is hope. We have a vaccine that by any measure is safe and effective, albeit not flawless and perfect, but when enough of us make that choice to protect ourselves with vaccination we are also extending that protection to those who will suffer the most from this illness.
The Centers for Disease Control recommends two doses of measles vaccine be given for children with the first dose at age 12 to 15 months and then the second dose at 4 to 6 years of age. Adults who don’t have evidence of immunity, international travelers and certain special groups of people may need additional measles vaccine. There are some medical conditions that prevent people from receiving the measles vaccine. Speak with your provider regarding your specific situation.
There is too much bad information out there to snuff out every lie and every misinterpreted data point in one article. Ultimately, the question is who and what do you trust? There is no hidden agenda, no big payout from "big pharma" awaiting me or any of my colleagues who advocate for immunizations. Taking care of the smallest, most-vulnerable people in our community, many of whom are too young to be vaccinated, is a privilege. My hope is that I never see a measles epidemic here in Sioux City because we chose as a community to prevent it through vaccination.
Doctor Jeremy Granger is a pediatric hospitalist at UnityPoint Health - St Luke’s in Sioux City.
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