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US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Re: US county bars unvaccinated children from public spaces amid measles emergency

Response to John Stone:

Measles is a highly contagious infectious disease caused by the measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). Less commonly seizures, blindness, or inflammation of the brain may occur. People are infectious to others from four days before to four days after the start of the rash. Once a person has become infected, no specific treatment is available. In May 2015, the journal Science published a report in which researchers found that the measles infection can leave a population at increased risk for mortality from other diseases for two to three years.

Prior to the vaccine, during the 1950s, when the U.S. had half its current population, more than 500,000 cases of measles occurred annually, up to 500 deaths, and 45,000 hospitalizations. The main cause of death, not the only one, was from opportunistic secondary bacterial pneumonias. Thankfully, the 1950s was the beginning of the era of antibiotics. However, with the rise of antibiotic resistant bacteria, nowadays, the possibility of a higher number of deaths is not inconceivable. Still, having ones child hospitalized, over and above the normal level of suffering from measles, can certainly NOT be a pleasant experience.

For a number of reasons, including survival of low birthweight and very low birthweight children, autoimmune diseases, and the advent of successful chemotherapeutic interventions for childhood cancers, there exists a number of children who are vulnerable to infections, quite simply, children that would have died early, nowadays live and can live long lives. And children under 1 year of age aren’t immunized because their immune systems haven’t developed to the point where they will successfully respond to a vaccine.

We usually live in dense urban environments. People have rights; but also responsibilities. Do we consign the above children to staying at home, not going to school, not going to parks, not going shopping with their parents? Not allowing visitors to their homes? Whether we have a vulnerable child or not, I think of the phrase: “There but for the Grace of God go I.” Individuals live in communities!

Stone writes: “Measles is not identified by the US government as a disease which requires quarantining.”

True; but neither is Ebola; yet quarantine was invoked. Until recently, thanks to Stone and other antivaccinationists, measles had been declared ended in the U.S. In addition, local Public Health Departments have the authority to act when necessary. We recently had an outbreak of Hepatitis A in my hometown and authorities acted, including mass vaccinating of the homeless.

Stone writes: “No evidence is presented about the vaccination status of either those who have caught or passed on the disease.”

True; but the vaccination rate among this small group of Orthodox Jews is about 74%, well below herd immunity and given a mass number of studies, we know that the vast majority of cases will be among the unvaccinated. And those who the vaccine failed to protect, if not exposed, if everyone around them had been vaccinated, would in most cases not have developed measles. In addition, we also know that when those vaccinated still get the disease, that most cases are milder than if not vaccinated. And, as pointed out above, the measles has been found to suppress ones immune system for several months, risking other infections.

Stone writes: “There was a time when almost everyone had natural immunity because they had caught the diseases as a child, but now many will have waning or failed immunity because of the inefficacy of the vaccine, and all we can do is vaccinate more with the inevitability that measles will still keep popping up.”

Yep, those 500,000+ who SUFFERED the 7 - 10 days infected with measles, the 45,000 hospitalized, the 500 or more who developed some lifetime disability, did develop life-time immunity, discounting the up to 500 who died and may have lived a long life, despite some possible pre-existing condition; but I, for one, would much rather get a quick jab every few years. And the “keep popping up,” amounts to in the 100s, not, given the doubling of the U.S. population, a million or more per year.

And finally, Stone writes: “This is at least very good news for the manufacturers.”

This is a standard trope of antivaccinationists, that governments, researchers, medical associations, etc. all are part of some grand conspiracy to further the profits of the pharmaceutical industry. In fact, since most of us supporting vaccines also vaccinated our children and selves, we must be willing to sacrifice ourselves and loved ones to further their profits. How utterly absurd! First, because certain vaccines are mandatory for children, in the U.S. various governments and large insurance companies negotiate low prices for them. Of course, the companies have to make a profit; but the net profit is much smaller than for other pharmaceuticals. In fact, world-wide the profits from ALL vaccines is less than 3% of all pharmaceuticals sold, though greater for some companies. In addition, doctors would make far more treating the sick kids, and the pharmaceutical companies far more treating, especially, the hospitalized kids. Pharmaceutical companies prefer drugs that are needed continuously, such as statins, and insulin.

Of course, pharmaceutical companies have to make some profit. If profit for anything is the criteria for deciding its worth, that is, is it beneficial, neutral, or harmful, then would Stone and other antivaccinationists advise people with diabetes NOT to use insulin, people with cancer to avoid chemotherapy, asthmatics, to not use albuterol, and on and on it goes? And the profit margins for the aforementioned are much much higher than for vaccines. In fact, one can challenge the pharmaceutical companies on their pricing of some meds; but it is the height of absurdity to keep harping on some conspiracy supporting vaccines to further profits.

Competing interests: No competing interests

31 March 2019
Joel A. Harrison
Epidemiologist
Long retired
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks