(PRESS RELEASE FROM INYO-MONO PUBLIC HEALTH OFFICER DR. RICK JOHNSON)
Vaccine Failure, or Failure to Vaccinate –
A Tale of 2 Outbreaks
There are currently 2 outbreaks of vaccine preventable disease affecting children in California. Since school is beginning again, I wish to address the unique aspects of each, and emphasize what parents need to do.
Pertussis – Vaccine Failure
Whooping cough (pertussis) is a highly contagious respiratory disease that typically causes spasms of coughing leading to vomiting. Infants and young children can have a severe course leading to lack of oxygen, pneumonia, seizures, brain infection, and death. Adults and teenagers have a more variable course ranging from mild to severe respiratory symptoms.
California is currently experiencing a shocking and widespread whooping cough (pertussis) epidemic. Pertussis is cyclical, and peaks every 3-5 years, as the numbers of susceptible persons in the population increases due to waning of immunity following both vaccination and disease. One reason for the increase is the use of acellular pertussis vaccines, which cause fewer reactions than the whole-cell vaccines that preceded them, but do not protect as long.
The last epidemic in California occurred in 2010; however, the overall incidence of pertussis has increased since the 1990’s. Mono County also experienced a peak in 2012. So far in 2014, over 7,000 cases have been reported in California, with one infant death. Almost 1,000 cases have been recorded in August alone! Los Angeles and San Diego are experiencing the most severe epidemics. No cases have been reported in the Eastern Sierra (Alpine, Inyo, and Mono) – yet! The concern? School is just starting, and the peak age is 15 years of age. Middle and high school students act to spread the disease throughout the community, although the highest risk of hospitalization and deaths is in the infants less than 4 months of age.
A number of activities should reduce the risk:
The primary DTaP vaccine series is essential for reducing severe disease in young infants and should not be delayed. DTaP can be given to infants at an accelerated schedule with the first dose given as early as 6 weeks of age. Even one dose of DTaP nay offer some protection against fatal whooping cough disease in infants.
School aged children should be up-to-date on their required vaccines. 5 doses of pertussis containing vaccine are required for kindergarten entry, with a booster required for entry to 7th grade.
Another key to protecting infants is for all pregnant women to receive whooping cough vaccine (Tdap) during the 3rd trimester of EVERY pregnancy. Pertussis antibodies are transferred from vaccinated mothers to their infants and will help protect them until they are old enough to be vaccinated.
A “cocoon” of vaccinated persons should be created around every newborn. This includes fathers, grandparents, and any other caretakers who will be part of this household.
Measles – failure to vaccinate
Measles is a highly contagious viral disease. It begins with a fever that lasts for a couple of days, followed by a cough, runny nose, conjunctivitis (pink eye), and a rash. The rash typically appears first on the face, along the hairline, and behind the ears and then affects the rest of the body. Infected people are usually contagious from about 4 days before their rash starts to 4 days afterwards.
It is widespread in many parts of the world, including Europe, Africa, and Asia. Although measles was declared eliminated in the US in 2000, this year is a record year, with 593 cases having been reported to the Centers for Disease Control (CDC) as of August 8th. As of August 15th, California has reported 61 cases of measles, most of whom live in Los Angeles or Orange Counties, and most are related to international travel. Virtually none have received adequate vaccination! The most common source is the Philippines, where 77,590 cases have been reported in 2014, with 44 deaths, mostly in children. Outbreaks are also currently ongoing in Russia, Wales, Ethiopia, Somalia, Tasmania, and New Zealand.
Children routinely get their first dose of the MMR (measles, mumps, rubella) vaccine at 12 months old or later. The second dose of MMR is usually administered before the child begins kindergarten but may be given one month or more after the first dose.
The measles vaccine is 99% effective at preventing disease. Some people choose to not immunize due to fear or incorrect science, but numerous studies have found no connection between autism and vaccines. A Dr. Wakefield conducted an improper study and had his paper retracted from the journal “Lancet”, but he had enough influence that people listen to him. He lost his license, but meanwhile children die. Infectious diseases that once regularly killed or harmed infants, children, and adults have been reduced or eliminated with vaccines. We’ve had such improvement that people have forgotten how devastating these diseases are. There are parents and doctors who’ve never seen these diseases.
According to the Centers for Disease Control and Prevention (CDC), vaccines contain the same antigens or parts of antigens that cause diseases, but antigens in vaccines are either killed or greatly weakened. Antigens do not cause disease. They make the immune system produce antibodies against them. Through vaccination, children develop immunity without suffering from the actual diseases. No vaccine is 100 percent effective. Immunization also helps those who cannot get a vaccine because they are too young, cannot produce antibodies or other medical reasons. Adults can also get measles if they are not vaccinated. Children under 5 and adults over 20 are at higher risk for measles complications including pneumonia, and a higher risk of hospitalization and death from measles than school-aged children and adolescents. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1000 children who get measles, one or 2 will die from pneumonia or brain infection. Therefore, if we have a single case in a school aged child, any child without adequate vaccination will be immediately excluded from school for up to 6 weeks.
Students (including college students), health care workers, and unvaccinated persons who are traveling outside of North or South America should receive MMR vaccine before they go. Infants who are traveling can be vaccinated as young as six months of age (though they should also have the two standard doses of MMR vaccine after their first birthday).
Some counties in California are at very high risk for an outbreak of measles, as more than 20% of students entering kindergarten are not vaccinated for philosophical or religious reasons. In the Eastern Sierra counties (Alpine, Inyo, and Mono), the numbers are less than 2%. Therefore, if we continue the current high levels of vaccination, our risk is small. Let’s keep up the good work!
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And, of course, stay home when you are sick, wash your hands, cover your cough with your elbow, drink and eat well, and get plenty of rest and exercise. Stay well!
Should you have any questions, or need assistance in obtaining vaccines, please contact your healthcare provider, a pharmacy, or the Health Department.