We live in an age where most young people now alive have never seen illnesses that were common 50-100 years ago. The medical system’s success at eliminating or significantly reducing common and deadly childhood illnesses through the use of vaccines has been dramatic. However, that success is now ironically causing more problems.Rates of parents “opting-out” (1, 2) of vaccinations is rising in many areas, causing these once rare diseases to become less rare. Even scarier, a 2011 survey found more recently graduated doctors had higher rates of doubts about vaccine efficacy and safety.
Recent outbreaks of measles in Texas, continuing in Europe, and even outbreaks of pertussis in areas around the US can be attributed to lower immunization rates. From a recent historical lesson, when the Soviet Union collapsed and the medical system was in disarray, lower immunization rates led to large-scale diphtheria outbreaks. In the case of pertussis an argument could be made that acellular vaccines, while better tolerated, have resulted in less long-lasting immunity. More often these outbreaks are in clusters of like-minded community members who chose to not vaccinate for a variety of reasons – whether religion, conspiracy theories, or the advice of friends and neighbors.
In 2010 there was a large spike in pertussis leading to 10 infant deaths in California. A recent study found that vaccine refusal played a role in this outbreak. Already in 2013 there have been more reported cases of pertussis than in 2012 but fortunately no deaths since 2010. A much larger proportion of the cases this year compared to 2010 appears to be among teenagers, a group that has been targeted for pertussis boosters in the last decade.
Just as a reminder, Mortality Statistics from 1908 showed it was a very difficult time to be a young person. Of all the deaths reported for that year, 27.5% were in children less than 5 years old and 19.7% were less than 1! The leading cause of death in the latter age group was “diarrhea and enteritis,” which had an overall mortality rate of 116 per 100,000. This was comparable to other overall death rates such as pneumonia (136) and TB (173.9). The list of conditions that affected children more were measles (10.2), pertussis (11), scarlet fever (12.4), diphtheria/croup (22.3), and typhoid fever (25.3). Interestingly enough, smallpox was at 0.2 with only 98 deaths reported in 1908, down from a five-year average of 1,119 from 1901-05. In 1907 a large scale outbreak in New York of 2,500 cases of a paralytic virus heralded the progression to an epidemic disease of global proportions by the 1940s, aka polio.
Jeff Ribordy, MD