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Measles Redux, The Unnecessary Epidemic

By Edwin J. Asturias, MD

This editorial appeared in The Denver Post Feb. 5.

Though dormant for years, measles reemerged this year with a vengeance. The first cases erupted in Disneyland before spreading outward, involving 14 states and counting. Now there are 102 confirmed cases, making it the largest measles outbreak since 1990.

This growing epidemic is fueling fierce debate over how to balance public health risks against the rights of increasing numbers of parents choosing not to vaccinate their children.

Measles is one of the most contagious diseases in the world. And the mathematics are cruel. In places where no immunity exists, every person with measles will infect 18 others, multiplying incessantly until everyone not vaccinated gets the disease.

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Dr. Asturias treats a child in the village of El Pomal, Guatemala. Photo: UC Denver

Before vaccines existed, this cycle repeated itself every three to five years as new cohorts of children without immunity were born. And with each cycle, one of every thousand died, one of every twenty got pneumonia, and some developed encephalitis, an often deadly brain infection. Prior to vaccination programs in the U.S., it was common to see 400,000 to 700,000 cases of measles every year along with many more complications and deaths. The measles vaccine made all of that a thing of the past, until another outbreak surprised us in 1989-91 causing more than 55,000 people to fall ill. Some 11,000 ended up in the hospital while 123 died.

As a pediatrician who has witnessed the suffering endured by unvaccinated children, I try mightily to put myself in the shoes of parents looking for more `natural’ ways to raise their kids.

They have the right to pursue the best balanced life for their families. Yet many of these often college-educated parents are duped by a few false prophets known to deceive in their quest for self-notoriety and fame.

Perhaps the most destructive has been Andrew Wakefield, the British researcher who fraudulently claimed a link between the Measles, Mumps and Rubella vaccine (MMR) and autism. Though exposed as a hoax, his legacy lives on among many who choose not to vaccinate their children. This despite that fact that most evidence has shown the measles vaccine to be overwhelmingly safe.

Then there’s Jack Wolfson, a cardiologist turned holistic and naturopathic healer, who claims it’s the `right’ of children to be infected with measles, mumps, rubella and chicken pox because viruses are part of the natural world. “Unfortunately, that means that some people get sick and some people die,” he says.

That’s a false and irresponsible choice. Medicine has progressed to the point where we can now save 90 percent of children with cancer and care for premature babies that would have died in the past. Meanwhile, our grandparents are living longer than ever. All of them are at higher risk of getting severely ill or dying from measles because their immune system it’s not optimal. So, are we really prepared to watch them get sick and die from preventable diseases? This is where the practice of being a naturalist fails, when the vulnerable among us die unnecessarily.

Highly contagious infections like measles can only be kept in check if more than 95 percent of us are protected. If not, the virus will find the communities with less immunity to spread. In Colorado, only 87 percent of children are fully vaccinated today, and this number has been equal for the past 10 years. In places like Boulder and Stapleton, the numbers are lower. We have had only one case in Colorado Springs, and may be spared an epidemic for a while given our population density, but believe me, when it comes, it will spread like wildfire as we have accumulated a good number of people without protection.

With one of every 10 parents now delaying or refusing to vaccinate their children, it’s time to ask whether they are making their choices based upon the best evidence or if they are following the advice of self-proclaimed, self-serving “healers.” I grew up in Guatemala and have seen more than my share of children suffer and die from preventable diseases, diseases their parents would have done anything to stop. I wonder if those who advise others not to vaccinate would feel the same way if they saw this kind of death and disease up close and personal. I wouldn’t wish that on anybody and I dare not to go back to the old days of the survival of the fittest.

Edwin J. Asturias, MD, is vice president of the Colorado Children’s Immunization Coalition Board of Directors, associate director of the Center for Global Health at the Colorado School of Public Health, associate professor of pediatrics at the University of Colorado School of Medicine, and works in the sections of general pediatrics and infectious diseases at Children’s Hospital Colorado.

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