• Measles and Rubella are disappearing, but not gone

    From JAMA Pediatrics, “The Beginning of the End of Measles and Rubella“:

    The elimination of measles and rubella from the Western hemisphere is a triumph of public health with several important implications. First, imported cases of measles and rubella will still likely occur as long as there remain endemic areas in the world. That these imported cases do not result in sustained transmission is confirmation that the level of population immunity is high enough for elimination. Prior to 1990, Mexico was the leading source of measles importations into the United States, but this year, half of all importations into the United States were from Europe. Since 2008, there has been a resurgence of measles cases in Western European countries. The majority of these outbreaks have been in unimmunized populations in countries where national immunization programs are being challenged by a combination of public and political complacency regarding the value of immunization and by the rising influence of antivaccination groups. After 500 years, we have now returned to a situation where the Americas are free from indigenous measles and rubella with Europe once again a source of importations.

    A second implication of the elimination of measles and rubella in the Western hemisphere is that it is a vindication of US vaccination strategy.

    Look, vaccines are just some of the most amazing medical achievements ever. Full stop. The fact that some of you want to “debate” this drives me crazy. More:

    Although the effect of expanded measles immunization in the United States has been a substantial decrease in morbidity, a notable effect in developing countries has been a substantial decrease in mortality. The aim of Millennium Development Goal is to reduce the overall number of deaths among children by two-thirds by 2015, compared with the level in 1990. There are now 550 000 fewer annual deaths from measles today than there were a decade ago. Fully one-fourth of all mortality reduction toward Millennium Development Goal 4 has been due to measles control. Over 30 African countries now have more than 80% measles vaccination coverage resulting in a 91% decline in measles mortality. The success of global measles and rubella control is largely due to an innovative partnership, the Measles-Rubella Initiative, which was started in 2001 and has since supported delivering more than 1 billion doses of vaccine.

    Why haven’t we totally eradicated these diseases?

    The greatest threat to the US vaccination program may now come from parents’ hesitancy to vaccinate their children. Although this so-called vaccine hesitancy has not become as widespread in the United States as it appears to have become in Europe, it is increasing. Many measles outbreaks can be traced to people refusing to be vaccinated; a recent large measles outbreak was attributable to a church advocating the refusal of measles vaccination. Even greater risk may come from parents who delay vaccinations rather than refusing them outright because a delayed vaccination may add more person-years of susceptibility than that due to refusing vaccination.

    Do I need to show you this again?

    Vaccinate your kids. Don’t delay.

    @aaronecarroll

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