Editor in Chief

Healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time. —C. Everett Koop (1916-2013)

by Chester Buckenmaier III, MD COL (ret), MC, USA

May 14, 2019

It has been with no small amount of dismay that I have watched national maps of the measles outbreak grow progressively redder on the national news as the epidemic continues to spread across the nation. Measles is a highly virulent, single-stranded, RNA virus that is endemic to humans and has no known animal reservoir. Measles is propagated as an aerosol from infected individuals coughing or sneezing and through direct contact with secretions. It is highly contagious with 90% of individuals who encounter an infected individual contracting the disease. Symptoms of measles develop after 10 to 14 days of exposure and typically involve fever, cough and a classic rash that appears a few days after the fever and spreads over the entire body. Fatality rates are low in countries with adequate population nutrition and healthcare systems, but in underdeveloped nations death rates can be greater than 25%. This is a serious disease and a significant public health issue for this country and the world.

Before the development of a vaccine for the measles virus in the 1960s followed by a combination vaccination called MMR (measles, mumps, and rubella) licensed and released in 1971, rates of infection for measles were so high in the United States that contracting the disease was assumed to be inevitable. The impact of the measles vaccine when it was first introduced in 1963 was dramatic and a public health triumph, with reported cases that were routinely in the hundreds of thousands per year dropping to tens of thousands in just a few short years  after the vaccine’s release. Rates continued to fall to just hundreds of cases nationally with MMR vaccination becoming a routine part of childhood healthcare.

The World Health Organization and United Nations Children’s Fund estimates that, between 1999 and 2004, 1.4 million deaths from measles was prevented through an aggressive global vaccination program. The MMR vaccination is highly effective, has saved countless lives and reduced untold suffering and is a critical component of any responsible nation’s public health plan. Concerns that this vaccination contributes to the development of autism in children have been scientifically disproved, and proponents of this medical myth are sadly ill-informed.

I find it unconscionable that the failure of a significant portion of our society to perform their civic duty to obtain recommended vaccinations has resulted in the resurgence of a disease medical science had conquered. The effectiveness of any vaccine within a community depends on the preponderance of the individuals in the community (usually more than 80%) receiving the vaccination. This is termed “herd immunity,” which basically prevents a contagious disease from spreading to individuals who cannot be vaccinated (infants, persons with weakened immune systems or other medical conditions that preclude vaccination) because of the large number of vaccinated persons in the community block disease transmission. In short, vaccine effectiveness in a population depends on individuals in the community being socially responsible and getting vaccinated. Reason would dictate that, even if an individual was purely motivated by self-interest, there is incentive enough to seek the vaccination to protect against personal illness. The misguided decisions of many who have not received the vaccination because of medically unfounded concerns, laziness or apathy are outrageous because this decision can, and often is, a death sentence to others in our community who are unable to receive the protection because of actual medical conditions.

I feel the events of the past few weeks regarding the measles outbreak is a disconcerting peek into our nation’s future, if the American public does not take its responsibility to be vaccinated for the sake of public health seriously. As the climate warms, diseases that traditionally have been isolated to warmer climates will be coming to our country. Among the many challenges that our society faces, the risks of national disaster from a highly contagious and dangerous communicable disease are very real.

With these new public health challenges looming on the horizon, we as a country cannot afford to become complacent in our management of diseases we have already overcome. Apparently, there is considerable fear within our patient population regarding perceived dangers that have been erroneously associated with vaccinations. As providers, we have a responsibility (as I have mentioned many times in this column) to educate patients and allay fears regarding the risks and benefits of vaccinations. Public health is a public responsibility, and maintaining one’s vaccinations is a civic duty.

As healthcare providers, we must make it a priority to remind our patients of their responsibilities in this regard. When we as a health system and society fail in this public health obligation, the consequences tend to play out in the nightly news as descriptions of human tragedy. We should heed this warning provided by the recent measles outbreak, because the next viral epidemic may not have a vaccine or be as relatively forgiving of this public health failure.



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