No Man is an Island – Not even at Kittery Pont


No Man is an Island – Not even at Kittery Pont
Healthy Living - May 8, 2015
William Sturrock, MD
Last week I received a health alert from the Maine Center for Disease Control, warning all providers that a measles exposure had occurred in Southern Maine.  Apparently an unvaccinated student from Europe had stopped at several stores including Calvin Klein, Ralph Lauren, J Crew, and the Kittery Trading Post, then subsequently had come done with a confirmed case of measles (Rubeola).  The warning read:  “people who were at the Kittery Mall from noon to 5 PM on April 20th should check their immunization records and be aware of potential symptoms”. 
The measles virus, which had not been reported in Maine since 1997, can survive for up to 2 hours in the air or on surfaces, and is highly contagious.  So far our state may have dodged this bullet since there has not been any report yet of new cases from this exposure.  But recently California was not as lucky – this past winter an outbreak triggered by a tourist from Asia at Disneyland infected over 150 individuals, and spread to 8 states plus Canada and Mexico.  Epidemiologists say this is the same strain that has stricken 58,000 people in the Philippines and killed 110. 
Although many think of measles as a minor viral illness of childhood that starts with a high fever, cough, runny nose and red eyes before the development of the characteristic rash, there are some who will develop serious symptoms of swelling of the brain that can be fatal or leave a survivor with significant neurologic disabilities.  Despite the fact that a vaccine has been available for decades, the World Health Organization estimates that 400 people died of measles every day last year. 
Surely one would think that educated folks in this country would want to make sure that they and their children were protected from this disease by the MMR (Measles, Mumps, Rubella) vaccine.  But sadly this is not the case as about one in ten Maine kindergartners were not protected, according to federal data.  This omission in the preventive care of our children does not come as much from negligence as it does from misplaced fear of the MMR vaccine.  Medical sociologists point to a now discredited report in 1998 that proposed a link between receiving the vaccine and developing autism as the beginning of this unfortunate ‘urban legend’.  The original article in the ‘Lancet’ was fully retracted after it was discovered that the author manipulated the evidence, and he now has been stripped of his medical license in Great Britain for multiple breaches of medical ethics. 
But if this were not enough to doubt this dubious link, CNN on April 22nd reported the results of the latest research into this issue from a study of over 95,000 children spanning an 11 year time-frame.  Even the higher risk kids who had an older sibling with Autism Spectrum Disorder showed no increased risk of this diagnosis with either 1 or 2 doses of the MMR vaccine. 
Realistically, will this latest research turn the tide on this dangerous undertow of anti-vaccine sentiment?  Unfortunately, I would say not.  Just as there are some who fervently believe the moon landing was staged on a Hollywood lot, or that Big Bird killed the Kennedy’s, there are always a few diehard who will hold onto this irrational belief with the fervor of the most rabid conspiracy theorist.  It is ‘human nature’ to have some contrarians disagree with public health science, just like the propensity of some to run a stop light or drive 10+ MPH over the speed limit. 
Now if we all lived on our own island in Casco Bay then the assertion of individual right to go unvaccinated would be a bold stroke for freedom, but the reality is far different from this political fantasy.  Every year children die or develop neurologic disability from measles brought to school by an unvaccinated classmate.  Even children who have already been vaccinated are at risk because sometimes the vaccine does not properly stimulate their immune system. And then there are the cases that spread to adults with cancer or other immune problems when they get exposed to their own kids or grandkids with measles. 
Due to this real concern, several states, including Maine have pending legislation that would make it harder for unvaccinated children to attend public school.  In the Maine version, parents who claim a religious or philosophical exemption from vaccines would have to make an appointment with a health professional to document that they had a full discussion of the risks of their vaccine avoidance.  Some states, such as Tennessee and Mississippi, have gone even further by not accepting anything except a health exemption (such as an immune disorder or cancer).  In these states, it is black and white:  no shots, no school.  While some may wince at this heavy-handed approach, there is no disputing the fact that these states have a much lower rate of these avoidable diseases compared to states that are more ‘liberal’ in granting exemptions.
It will be interesting to see how this public health battle plays out.  Those of us who have seen the serious effects of these illnesses like measles have a hard time staying quiet.  I keep hearing the last part of John Donne’s quote about no man being an island.  It goes like this:

                                          ‘Any man’s death diminishes me, because I am involved in Mankind. 
                                           And therefore never ask for whom the bells tolls,
                                            It tolls for Thee.’
1. How does measles compare with other serious infections in its potential to be a great public health risk? 

While it can have more severe health consequences than the other 2 viruses (Mumps and Rubella, aka German Measles) in the MMR vaccine it cannot compare to the scourges like smallpox which has a very high rate of lethality and can wipe out whole human populations that are unprotected.  Still, before the vaccine was widely distributed it resulted in the death of 2.6 million people in the world every year.  To put this in perspective, this is 3 times greater than the deaths per year of breast, cervical and ovarian cancers combined.
2. I’ve heard that there is mercury in vaccines – how safe can that be to inject into a baby? 

Thimerosal which is a preservative, does contain mercury but since 2001 it has been removed as a precaution from all childhood vaccines, and was never in the MMR.   It does remain in some flu vaccines, but the exposure is less than what is in breast milk.  We still believe strongly that the benefits of breast milk outweigh the risk of this trace amount of mercury, and the same is true for the flu vaccines.