Measles Outbreak, 2018-2019 & More on Coronavirus in Georgia

A recent report (JR Zucker et al. NEJM 2020; 382: 1009-17) highlights an outbreak of a vaccine-preventable disease, measles.  Measles is much more contagious than the recent coronavirus; this is one reason why a vaccine is so crucial.

In total, there were 649 cases confirmed –most of the cases were in a close-knit community in Brooklyn, NY.  86% of the cases with a known vaccination history occurred in those who were unvaccinated. 49 required hospitalization.  The cost to the Department of Health was $8.4 million.

My take:  The health consequences and cost of not preventing measles is staggering -though being eclipsed by the coronavirus pandemic.  The toll in Europe has been much higher.  Worldwide more than 140,000 died from measles in 2018.

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From Georgia Department of Health: COVID-19 Status Report

It is important to understand that some data, particularly in the last 2 weeks, may not be reported yet.

Related blog post (April 24): Why Georgia Isn’t Ready to Reopen

Measles Outbreak

704 Measles cases for this year were reported on April 30th. It is likely to climb much higher. More than 40,000 cases were reported in Europe in the first 6 months of 2018.

Related article: NY Times: Should Adults Get a Measles Booster Shot?

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Just Saying…Vaccines Don’t Trigger Inflammatory Bowel Disease

The other day I was having a fun discussion on words that we may choose before providing information that others might not like.  Some examples:

  • “No offense but”…
  • “Don’t take this the wrong way”…
  • “Just saying”…

A recent report (GP de Chambrun et al. Clin Gastroenterol Hepatol 2015; 13: 1405-15) debunks claims that vaccines increase the risk of inflammatory bowel disease (IBD).  A report by Thompson NP et al (Lancet 1995; 345: 1071-74) suggested that measles vaccination could increase risk of IBD.  In the current study, the researchers examined 11 previous studies for review and meta-analysis.  Vaccines included: BCG, DPT, smallpox, poliomyelitis, pertussis, H1N1,measles, mumps, rubella, and combined MMR.  This study included 2399 patients with IBD and 33,747 controls. Bottomline: “Results of this meta-analysis show no evidence supporting an association between childhood immunization or H1N1 vaccination in adults and risk of developing IBD.” With regard to the measles vaccine in particular, the relative risk was 1.33 (CI 0.31 -5.80) in cohort studies and the relative risk was 0.85 (CI 0.60 -1.20) in case-control studies.

What types of words do you hear people use before saying something someone is not going to like?

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Another Big Study: No Link between MMR vaccine and Autism (Plus one)

In a study with 95,727 children, there was no link between receipt of the MMR (measles, mumps, rubella) vaccine and autism, even in children at high risk (eg. sibling with autism).

Here’s a summary from USA Today: No link between MMR and Autism

Original JAMA article (free & entire article)

Related blog: “Too many vaccines and autism” is debunked | gutsandgrowth

An unrelated commentary, “Social Distancing and the Unvaccinated,” (NEJM 2015; 372: 1481-83) notes that a recent ruling (Phillips v City of New York) upholds the state’s authority to bar unvaccinated children from school during outbreaks.  This practice is referred to as social distancing to lessen likelihood of further transmission. This “reiterated the Supreme Court decision in the 1905 case Jacobson v. Massachusetts, which clearly found vaccine mandates constitutional.”

GI Care For Kids: Our group has been very supportive of the Crohn’s and Colitis Foundation of America (CCFA) and especially active in staffing the yearly Camp Oasis for more than 20 years.  Throughout the year, there are a number of other events to support CCFA.  This past weekend many of us participated in “Taking Steps.”  Here are a few pictures:

Super Poopers: Ben Gold, Larry Saripkin, Dinesh Patel, Seth Marcus, and Jay Hochman

Super Poopers: Ben Gold, Larry Saripkin, Dinesh Patel, Seth Marcus, and Jay Hochman

Dr. Spandorfer’s team raised a great deal of money (50K) and he/his family were featured in the Atlanta Journal Constitution (Local Family Takes Big Steps to Raise Awareness).  His son, Jack, spoke at the event, and was honored as this year’s hero.  They also had pretty clever T-shirts

With 'Pip" Spandorfer (whose team raised $50,000)

With ‘Pip” Spandorfer (whose team raised $50,000)

Dinesh Patel and Kimberly Sheats

Dinesh Patel and Kimberly Sheats

 

 

 

Vaccine Safety Comic Book Version – Will It Help?

The following link (from Jeff Lewis’ twitter feed) provides a terrific review and summary of the effectiveness of vaccines, the debunked myths, and how “anti-vax” movement hurt not just themselves but others too.

Vaccines Work, Here Are the Facts -Cartoon

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More Measles Cases -Here’s the Data

This past month a recent perspective article (NEJM 2014; 371: 1661-3) provides an update on measles and the problems with vaccination rates.

Key points:

  • More measles cases in 2014 (592 thru Aug 29) than in any year in the past 20.  Already, the number of cases this year is >3-fold the number in 2013 and ~10-fold more than in 2012
  • Most cases are due to infections acquired during travel or due to cases being brought into U.S. by foreign travelers
  • Problem has expanded due to increasing number of unvaccinated children.  Vaccines “that remain in the vial are completely ineffective.”
  • Measles remains one of the most contagious illnesses and typically one person can infect up to 18 susceptible persons.  Due to its contagiousness, a high level of herd immunity (>92-94% immune) is needed to prevent sustained spread of virus.
  • Measles can be deadly with case fatality rate of 0.2% to 0.3% in the developed world and much higher in the developing world (2-15%).
  • Even a few cases are very expensive to control. A 2004 Iowa outbreak of only three patients cost more than $140,000 to contain/investigate.  An outbreak in Arizona with only 7 patients cost more than $800,000.

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Measles, Seizures and Sometimes Death due to Vaccine Delays and Avoidance

Three recent news items provide more up-to-date reasons for childhood vaccines.

1. Delaying vaccines may increase seizures –here’s the link and an excerpt (from NY Times):

Some parents postpone their children’s vaccinations because they believe the delay decreases the risk. But a new study finds the opposite may be true.

The analysis, published online in Pediatrics, involved 5,496 children born from 2004 to 2008 who had seizures in the first two years of life.

For children who received any of their shots as recommended before age 1, there was no difference in the incidence of seizure in the 10 days after vaccination compared with the period before vaccination. But compared with giving it in the first year, giving the measles-mumps-rubella vaccine at 16 months doubled the incidence of seizure, and giving the measles-mumps-rubella-varicella vaccine at that age increased it almost six times.”

 

2. Rate of measles infections at 20 year high –here’s the link and an excerpt: (from USA Today)

The USA has the most measles cases in 20 years…The confirmed case count for 2014, as of May 23, was 288 and growing, the CDC says. That number includes 138 cases from Ohio, where the biggest outbreak is ongoing – and where the actual count is 166 as of Thursday, according to the state Health Department.

The nationwide total is the highest for late May since 1994, when 764 cases were reported, the CDC says. It surpasses the 220 cases reported in all of 2011, which was the most in the post-2000 era.

“This is not the kind of record we want to break, but should be a wake-up call for travelers and for parents to make sure vaccination records are up to date,” said Anne Schuchat, director of the CDC’s National Center for Immunizations and Respiratory Diseases. Schuchat…Before the measles vaccine became available in 1963, the virus infected about 500,000 Americans a year, causing 500 deaths and 48,000 hospitalizations.

Cases this year have been reported in 18 states and New York City. Ninety percent have been among people who have not been vaccinated or have unknown vaccination status, according to the CDC. Most of the patients report religious, philosophical or personal reasons for avoiding vaccines.”

 

3. When parents withhold vaccines, vulnerable children get sick and sometimes die  –here’s the link (reference noted from Eric Benchimol’s twitter feed) and an excerpt:

Jason Lawson recalled a terrifying 10 days in B.C. Children’s Hospital when his son Beckett was six, after Beckett became severely ill from chicken pox.

At the time, Beckett was still receiving a maintenance dose of chemotherapy to kill potential cancer cells. That treatment also suppressed Beckett’s immune system.

When an unvaccinated child at the school passed on chicken pox, the consequences were dire — at one point the virus got into Beckett’s liver and started to do damage, which in some cases can be irreversible….

Lawson said he’s speaking out to remind families that protecting their friends and neighbours is another good reason to make the effort.

Take home message:  With every medical intervention, there are risks and benefits.  Those who forego vaccines increase the risk for themselves, their families and friends.

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