Will measles become the next pandemic? a book review

Diseases that haven’t occurred much in the past 20 years are making a comeback all over the world. And they are largely preventable.

Influenza has arrived in the United States with some areas already experiencing epidemics. We pretty much expect this to happen in the winter despite wide availability of influenza vaccine.

But other diseases that haven’t been seen much in the past 20 years are making a comeback all over the world. The number of measles cases continues to climb, with 5 countries accounting for half of the world’s victims- Congo, Liberia, Madagascar, Somalia and Ukraine.

In 2019 the United States almost lost its measles elimination status because of a nearly year-long measles outbreak in New York, with the greatest number of measles cases since 1992. The New York State Department of Health declared the outbreak over in October, and the Centers for Disease Control and Prevention announced it would maintain the country’s elimination status.

And in a part of the world that conjures up images of a tropical island with sunny skies and pristine beaches, Samoan children are dying of measles due to increasingly low vaccination levels, currently only 31%. Over 5,100 measles cases have been reported since the outbreak, with 74 recorded in a recent 24-hour period alone, according to Samoa’s government. 

The low vaccination rate this year was caused in part by distrust of vaccinations that spread last year after two infants died after a vaccine error- nurses incorrectly mixed vaccines with another medicine. The accident compounded the worldwide spread of misinformation about vaccines. 

The anti-vaccination movement made the list of the World Health Organization’s top threats to global health in 2019

CBS NEWS

I don’t know if anyone has suggested it , but it seems we may be entering a pandemic of measles. Here is a review of a book explaining what that means.

Pandemic by Sonia Shah

Sonia Shah , a science journalist, has built a career  writing about medical science. She explains the “what”  of her book in the subtitle-

Tracking contagions from cholera, to Ebola, and beyond

And she answers the “why” in the introduction-

“By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.”

Let me back up and define some terms.

Pathogen– any disease producing agent, but especially referring to a living  microscopic organism, such as a virus, bacteria, or  parasite; this includes the organisms that cause Lyme disease, Ebola, West Nile, HIV, bird flu, even the common cold

Epidemic– the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less.

Pandemic– a disease outbreak that spreads throughout a country, continent, or the world, as opposed to an epidemic, which is localized.

map of the world
In a pandemic, an infectious disease may spread all around the world.

Why infectious disease still matters

With healthcare focus on chronic diseases like heart disease, diabetes, cancer, and dementia, even physicians can get lulled into thinking that infectious disease has been conquered and no long a serious medical threat. This book reminded me that is not the case.

Ms. Shah recounts the history of cholera, which has caused epidemics on every continent except Antarctica, focussing on the epidemics which devastated London, New York City, and more recently Haiti.

Cholera is rare in the United States now, but in the past it has been deadly here and throughout the world. Cholera, an infection due to a bacteria Vibrio cholerae causes severe uncontrollable diarrhea which quickly renders its victims helpless, dehydrated and critically ill. The bacteria lives in and is spread by contaminated water, but for many years physicians did not know this; and even when some doctors recognized this, others refused to believe it. Thus the opportunity to control it and prevent thousands of deaths was delayed .

bacteria under the microscope
photo of the Vibrio cholera bacteria under a microscope; used courtesy of CDC/ Dr. William A. Clark

how disease spreads

The author explains how cholera and other infectious diseases cause so much human suffering by detailing “How disease spreads” in these  chapter titles.

Locomotion– Humans and pathogens travelling from place to place spreads disease.

Filth-Waste management and in some cases mis-management, leads to contamination of drinking water by human waste.

Crowds-People living in crowded slums creates perfect conditions to spread disease person to person.

Corruption– Public officials and business people who place profit and power above public health.

Blame No one willing to take responsibility for making hard choices, and too willing to blame someone else.

Ms. Shah uses examples from her personal life, like her annual family trips to India to visit relatives who lived in less than clean and sanitary neighborhoods. She also shares her and her sons’ battle with skin infections due to  MRSA, a form of staph (staphylococcal) that is resistant to many antibiotics and can be difficult to eradicate.

Pandemic includes extensive footnotes and a glossary of terms used in the book.

If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.

Here are other resources about how infections spread and how they can be stopped

For a visual lesson on how pandemics occur, watch this video.Warning: it is rather graphic. 

“How Pandemics Spread”

created by Mark Honigsbaum and animated by Patrick Blower 

 

When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed

by Howard Markel

“Medical historian and pediatrician Howard Markel, author of Quarantine! tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.”  (quote from Goodreads)

 At this link read how Dr. Gretchen LaSalle

blows the whistle on anti-vax false claims

an excerpt-

“Vaccines are recommended for personal health and required for the greater good. To protect those who can’t be vaccinated and to preserve the health of our communities, many vaccines are required for school entry. If you choose to participate in the community (ie, attend school), you have a duty not to harm those you come into contact with. And if you can’t make that decision for yourself, sometimes the states have to step in and make that decision for you. But still, you always have the choice to keep your kids out of school. The consequence for you is that you are now in charge of educating your own children. The consequence for your child is that their health is at risk and they are deprived of socialization and interaction with their peers. But, hey. You always have a choice! “

For a review of vaccine preventable diseases read my previous post

Vaccination prevents disease

exploring the HEART of preventing disease through vaccination

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

These are affiliate links you may find helpful and which help fund this blog with a commission when a purchase is made using them.

World Vision – Sponsor A Child Today. Help give children a better future. Sponsor a child through World Vision and change a child's life and community for good.

Measles- not gone, not forgotten

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

A “RASH” OF MEASLES CASES

Measles in the U.S. has climbed to its highest level in 25 years, closing in on 700 cases this year in a resurgence largely attributed to misinformation that is turning parents against vaccines.

“This is alarming,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. Not only is measles dangerous in itself, but its return could mean other vaccine-preventable diseases seemingly consigned to the past may be coming back as well, he said.

APNEWS.COM, APRIL 24, 2019

The rash of measles, also known as rubeola, starts on the head and spreads to the trunk (chest and upper back) , arms, and legs over a few days .

What is measles?

At one time, measles was one of the “usual childhood diseases” that most of us over age 55 years contracted as children, prior to the use of the vaccine. It is caused by a virus in the Paramyxoviridae family and spread by person to person contact.

The other childhood diseases were

  • Rubella, or  German measles
  • Chicken pox, or  varicella
  • Roseola
  • Fifth Disease, or erythema infectiosum

These all cause a rash, called an exanthem.

Mumps was also a common childhood disease but does not usually cause a rash.

Symptoms of measles include cough, nasal drainage, reddened, inflamed eyes, and a rash as pictured below.

the rash of measles
image courtesy of the CDC- Centers for Disease Control , U.S. government

There is no specific treatment and it runs its course in about 1-2 weeks. Antibiotics are not effective .

Most of those infected recover uneventfully but there can be serious complications including pneumonia and encephalitis (inflammation of the brain).

Preventing measles and other exanthems

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

Measles vaccine is usually administered as a “3 in 1” vaccine- the MMR, which has been vilified as a possible cause of autism, although that has been thoroughly discredited.

The other two letters in the mix stand for mumps and rubella (also known as German measles) both of which are also caused by viruses and for which no treatment exists.

No vaccine exists for roseola or Fifth Disease, but we have an effective vaccine for varicella, commonly called chickenpox.

MEASLES OUTBREAK ELSEWHERE

According to the World Health Organization, WHO, Europeans are also contracting the most measles cases in 30 years.

The WHO European Region comprises 53 countries, from Andorra to Ukraine. According to data from the WHO, 41,000 measles cases were reported from January to June 2018 across those countries, including 37 deaths — a record-high number of fatalities since the 1990s.

CBSNEWS.COM, JUNE 17, 2019

sharing the HEART of health

My family receives vaccines and believe any potential risk is worth the benefit. I urge you to think carefully and talk to a trusted physician before you decide to forgo vaccination for yourself and especially for your children.

Thanks for visiting this blog and considering this vital information as we explore the HEART of health together.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

Dr. Aletha 

Vaccination prevents disease- part 2

In part 1  I discussed the vaccine preventable bacterial diseases . Here we’ll look at viral infections.

 

Virus vs Bacteria

One major difference between bacterial and viral infections is the treatment. We have many more effective antibiotics (drugs which fight bacteria) than we do antiviral drugs.

And antibiotics do not affect viruses. Despite that fact, patients often expect and even demand their physicians prescribe antibiotics for viral infections such as influenza, colds and bronchitis- and unfortunately too often we physicians do it anyway.

 

6 smart facts about antibiotic use

 

Influenza- the vaccine is given annually and targeted to the strains of virus predicted to be active in any given year.

symptoms of influenza
The nasal flu vaccine is not preferred as it is less effective than a shot. 

 

 

 

 

 

 

 

 

Measles (rubeola), Mumps, Rubella (German measles) -I am grouping these together since their vaccines are usually given together as the MMR. Recent outbreaks of measles have been attributed to the decline in vaccination rates.

Measles in the United States

Polio, a disease parents feared when I was a child, due to to risk of permanent paralysis, now essentially eradicated in the United States

Rotavirus,  in infants and small children, a common cause of gastroenteritis- vomiting and diarrhea, with or without fever and abdominal pain

HPV, the human papilloma virus, causes warts of all kinds, but the vaccine is targeted to the strains that cause genital warts and can lead to cervical cancer

The cousin viruses, Hepatitis A and Hepatitis B.

Hepatitis is an infection  of the liver, which can range from a mild disease to life threatening. Hepatitis A is spread through contaminated food or water. Hepatitis B is spread through contact with infected blood or other body fluids.

Another set of cousins, Varicella Zoster (VZ) virus causes two different infections and thus has two vaccines. The original infection is  varicella or chickenpox, formerly a common childhood illness but not seen often now due to the vaccine. When it reactivates, usually years later in adulthood, it is known as  zoster or shingles.

 

 

There are also several vaccines usually reserved for travel to specific areas of the world, occupational exposure, military service or other special circumstances. These include vaccines for anthrax, typhoid, cholera, (bacteria) and yellow fever, smallpox,and rabies (viruses). 

Diseases for which there is no vaccine

One of the most serious is malaria, caused by a parasite transmitted by infected mosquitos. Malaria is rarely a risk in northern or extreme southern areas of the world, but for the tropics, especially sub-Saharan Africa it is a major health problem.

Otherwise we all are at risk of other serious infections that we cannot yet prevent with immunization. These include

HIV-human immunodeficiency virus ,and most other sexually transmitted diseases including HSV- herpes simplex virus, gonorrhea, syphilis, and chlamydia.

HCV- Hepatitis C

Most respiratory viruses, including rhinovirus, cause of the common cold; RSV-respiratory syncytial virus and infectious mononucleosis

The Ebola virus

 

Borrelia, not really a bacteria, it’s a spirochete, which causes Lyme (not lime) disease

And the bacteria Staphylococcus, which causes “staph” (not staff) infections of the skin and Streptococcus, which causes “strep throat”

If you have any questions or concerns about which vaccines you might need to protect yourself against infections, please consult your own personal physician.

Detailed information about vaccines and infectious disease  is available from the Centers for Disease Control and Prevention 

 

Vaccination prevents disease- part 1

The rash that spreads- what you need to know about measles

Measles and mumps- 2 old diseases that are making a comeback #measles#mumps

You may continue reading here, but there is an updated version at this link

Measles, not gone, not forgotten

The rash of measles, also known as rubeola, starts on the head and spreads to the trunk (chest and upper back) , arms, and legs over a few days .

What is measles?

It used to be one of the “usual childhood diseases” that most of us over age 55 years contracted as children, prior to the use of the vaccine. It is caused by a virus in the Paramyxoviridae family and spread by person to person contact.

The other childhood diseases were

  • Rubella, or  German measles
  • Chicken pox, or  varicella
  • Roseola
  • Fifth Disease, or erythema infectiosum

These all cause a rash, called an exanthem.

Mumps was also a common childhood disease but does not usually cause a rash.

Symptoms of measles include cough, nasal drainage, reddened, inflamed eyes, and a rash as pictured below.

the rash of measles
image courtesy of the CDC- Centers for Disease Control , U.S. government

There is no specific treatment and it runs its course in about 1-2 weeks. Antibiotics are not effective .

Most of those infected recover uneventfully but there can be serious complications including pneumonia and encephalitis (inflammation of the brain).

Preventing measles and other exanthems

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. Thus public health officials consider an outbreak a major setback in the control of infectious disease.

Measles vaccine is usually administered as a “3 in 1” vaccine- the MMR, which has been vilified as a possible cause of autism, although that has been thoroughly discredited.

The other two letters in the mix stand for mumps and rubella (also known as German measles) both of which are also caused by viruses and for which no treatment exists.

No vaccine exists for roseola or Fifth Disease, but we have an effective vaccine for chickenpox.

You can listen to  2 DOCS TALK  about mumps at this link or read the transcript.

Mumps – The Disease, the Vaccine, the Problem

“But recent increases in those who choose to have their children forego vaccines has led to a loss of herd immunity and an increase in these outbreaks.

To further complicate the issue, it seems that immunity wanes with time, which is why many college students (hello spring break!) find themselves falling ill eight to ten years after their last booster at age 12 to 15.”

My family receives vaccines and believe any potential risk is worth the benefit. I urge you to think carefully and talk to a trusted physician before you decide to forgo vaccination for yourself and especially for your children.

Thanks for visiting this blog and considering this vital information as we explore the HEART of health together.

Dr. Aletha 

Should your family receive vaccinations?

This post is being updated with the current CDC vaccination recommendations. With a few exceptions for medical reasons I believe all adults should discuss vaccination with their physician and be immunized for any diseases for which they are at risk.

Current vaccination recommendations, 2019

This post is being updated with the current CDC vaccination recommendations. With a few exceptions for medical reasons I believe all adults should discuss vaccination with their physician and be immunized for any diseases for which they are at risk.

And I recommend that parents do the same for their children and adolescents.

RECOMMENDED ADULT IMMUNIZATIONS 2019
RECOMMENDED CHILD AND ADOLESCENT IMMUNIZATIONS 2019

Some questions to ask about vaccines and the immunization process include.

  • What contagious diseases is a person likely to be exposed to?
  • What are the risks of those diseases?
  • What are the risks of a particular vaccine for that person?
  • What are the risks versus benefits to other people?
  • What else can we do to prevent an infection?

Infectious disease control methods

The  developed countries  have eliminated or controlled many of the environmental sources of contagious disease by manipulating our environment.

  • indoor plumbing
  • water treatment facilities
  • screens on windows
  • air purification
  • wear gloves to prepare food
  • inspect restaurants
  • signs in many public restrooms reminding us to wash our hands.
Hand hygiene saves lives.
Hygiene remains vital to infection prevention even when immunizations are given.

However, we have not eliminated another source of infectious disease- and that is other humans.

Rarely do we isolate or quarantine people with infections. Most of us have gone to work, school or social events with symptoms suggestive of infection- a cough, runny nose, upset stomach- putting our friends and colleagues at risk.

Please review these excellent resources on vaccine use

A basic review of  Childhood vaccines  and Adult vaccines from UpToDate, a researched, non- commercial medical publication for doctors and patients

The Science Behind Vaccination from The New York Times

 7 things about vaccines from The Washington Post

Reconsidering vaccination a blog post review of the book The Vaccine Friendly Plan

Voices for Vaccines – a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

Thanks for reading and sharing this important information about protecting the HEART of health.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

Dr.  Aletha