Measles: It’s not a small world after all
It’s 2015, and we’re talking about measles. Not Enterovirus. Not Ebola. Not RSV. Not influenza. Instead, we’re talking about a historical virus that was declared eradicated from the United States in 2000. Most pediatricians who began practicing within the last 15 years have never even seen the disease.
Measles starts as a high fever followed by a cough, runny nose (coryza), red and watery eyes (conjunctivitis), and tiny white spots inside the mouth (called Koplik spots) plus a characteristic rash that appears several days later. People with measles are usually contagious four days before appearance of the rash until four days after it has resolved. In late 2014, we were warned that measles was much more contagious than Ebola. Measles is transmitted through coughing and sneezing. What’s worse, it can be spread from infected surfaces, and it’s airborne. Measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected.
The measles vaccine, introduced in 1963, caused a drastic decline in the number of cases of the disease. But by 1970, there were 47,000 cases and by the next year, 75,000 cases. Before the vaccine, measles infected as many as four million American children, hospitalizing 100,000, and killing 500 of them each year. History has taught us that when immunization rates decline beyond a certain threshold (usually less than 95 percent for highly contagious infections like measles or pertussis), outbreaks occur.
I’ve had countless conversations with parents who are hesitant about vaccines. Some simply want to hear that immunizations are safe. Others flat out refuse to listen to sound evidence, citing conspiracy theories or unfounded safety concerns. Most, I’ve found, have no reasoning at all. They are simply unsure if vaccinating is right for them. I genuinely think most people who choose not to vaccinate their children mean no harm. They just don’t think the dangers of contracting a vaccine-preventable disease outweigh the very small chance of sustaining an adverse event by vaccinating. Many of the vaccine-preventable illnesses have been non-existent for so long that many parents are unaware that some of the diseases exist, let alone realize how dangerous or deadly they can be.
As a pediatrician, I’ve realized you can catch more flies with honey. To browbeat parents into a non-vaccination corner or boot them from a practice does nothing more than create angst and resentment. But, let’s be clear. I do not support alternative vaccine schedules nor do I support skipping or delaying recommended vaccines. I believe the currently recommended vaccines and schedule endorsed by the American Academy of Pediatrics and the Centers for Disease Control and Prevention are safe and effective.
That being said, I should not restrict children from access to medical care based on their parents’ decisions, even if I do not agree with them. Pediatricians, unfortunately, are asked to walk a thin line. We have just as much of an obligation to protect our other patients who are vaccinated. If this means always presuming a fever and a rash in a non-vaccinated child is a potentially life-threatening illness (like measles) until proven otherwise and asking the family to wait in the car (instead of the waiting room) until being called in (by phone) via a back entrance so as not to expose the other (vaccinated) patients, so be it. Ultimately, the root of our relationships as pediatricians with patients and their families is based on trust. If we are not trusted on basic science principles like vaccine safety and effectiveness, it’s going to be tough to trust us on anything.
Fortunately, most pediatricians follow a science-based vaccine schedule and are against the anti-vaccination or alternative vaccine scheduling rhetoric being pushed by vocal celebrities and famous anti-vaccination friendly doctors (like Dr. Bob Sears and Dr. Jay Gordon). Unlike Ebola, there is a known simple solution for halting measles: vaccination. It’s time that American parents stand up (alongside their pediatricians) and let their peers know a choice not to vaccinate is a choice to put everyone else at risk. It is a personal decision, but it affects others as well. Find out if your child’s school and playmates are vaccinated. We ask about accessibility to guns or alcohol when our children want to play at their friends’ homes. Do you know if they are protected against dangerous diseases there as well?