Outbreaks remind us why vaccines are important

I was a senior in medical school when I got the measles. I thought about my delayed run-in with childhood diseases as I perused the New England Journal of Medicine recently.

There I found an article about the 2005 outbreak of measles in Indiana. This despite the fact that in 2000 a group of medical bigwigs from the Centers for Disease Control declared that measles was no longer endemic in the United States. Because of the vigorous vaccination of our children, the only measles we see in our country has hitched a ride from somewhere else.

When a vaccine-preventable disease like measles becomes rare, we forget about the serious complications like pneumonia, encephalitis and even death that it can cause, and instead focus on problems, real or perceived, with the vaccine. Parents might opt to keep their children unvaccinated, figuring that measles isn’t a problem anymore.

In 2005 in Indiana, a 17-year old girl returned home from a mission trip to a Romanian orphanage, where she had unknowingly become infected with the measles virus. The day after she returned home, she attended a large church gathering. Many of the children at the gathering were, like her, unvaccinated. Fourteen days later (the incubation period of measles), a 6-year-old girl was hospitalized and the largest outbreak of measles in the U.S. since 1996 began.

We’re not talking huge numbers here – ultimately, the Indiana State Department of Health identified 34 cases of measles. Measles is a reportable disease, so when a doctor or health clinic makes the diagnosis, someone lets the local health department know. These many cases of a vaccine-preventable disease raised a red flag, and the medical detectives went to work.

They found that 33 of the 34 patients were members of the church that held the gathering. Eighteen were infected at the gathering. One more was infected by the teenage missionary during a visit to her home.

Thirteen lived in households with a patient infected at the gathering. Although those infected at the meeting were out interacting with the community before the health department took steps to contain the outbreak, there was no transmission in the community or health-care settings, with one exception. A lab worker, whose job it was to draw blood, became infected. Her hospital was the treatment site for two of the patients. She became so ill she was hospitalized with severe respiratory distress, a reminder that measles can be dangerous.

The health department sought to contain the disease in several ways. It asked patients with measles to voluntarily quarantine themselves. It offered measles vaccine to those who had been exposed and were not immune from previous illness or vaccination.

And because the majority of the community had been vaccinated against measles, the outbreak petered out.

But not before some warnings were raised. Thirty-two of the patients had not been vaccinated because of concerns related to vaccine safety, despite the fact that scientific studies show no link between the vaccine and autism, the primary concern of those who refuse vaccination.

The hospital worker exposed patients with compromised immune systems – those receiving chemotherapy for cancer, those with AIDS, and infants – to what could, for them, be a fatal disease. Only four states (Maine, New York, Oklahoma and Rhode Island) have laws mandating that all health-care workers in hospitals have proof of immunity. (Although Deaconess Medical Center here checked me when I was hired on.)

This outbreak showed us that it is not disadvantaged children failing to get preventive care (we’re getting pretty good at getting vaccines out to those children), but rather those who refuse vaccination who are getting measles. It also showed us that we truly live in a global community. Failing to get vaccinated in the United States, where measles has been all but eliminated, might work if the disease didn’t hitch a ride in an unvaccinated teenage missionary doing good work in a country where measles is still rampant.

Dr. Stacie Bering is a Spokane physician. Contact her with general questions and topics for future columns by mail at Dr. Stacie Bering, Features Department, The Spokesman-Review, P.O. Box 2160, Spokane WA 99210 or by e-mail at doctorstacie@mac.com. She cannot answer personal medical questions in her column.