The myth of mild measles

9 Oct

One of the common arguments from vaccine rejectionists is “These diseases aren’t really that bad”. Often this includes graphs of death rates over time, with the suggestion that the diseases were already going away by themselves when the vaccination program started. It boggles the mind that intelligent people can make that claim, but they do.

The other argument is that with modern medicine and sanitation, the diseases were not a big problem. Again, mind boggling.

People will say, without any hint of irony, “I got the disease and I didn’t die.” The response being so obvious (the dead people aren’t here to speak) that I am astounded that these people make this claim.

More recently, I’ve seen a few blog posts where old news stories are picked out and people say, “See, they didn’t think these were that dangerous”. How many times can I say “mind boggling” in one post?

That all said, I decided to look through old news stories to see what people thought of Measles over time. As it turns out, some really good stories were in Time Magazine, so I will use that as the source.

Let’s scroll back to 1934. In a piece simply titled Measles, Time states:

New York City’s Health Commissioner Rice warned parents to beware of measles as a “very serious malady,” but assured them that this is not a “measles year” in New York. In the first ten weeks of last year the city had 9.562 cases and 44 deaths, against 413 cases and two deaths for the same period this year.

It wasn’t a “measles year”, as in, this wasn’t a big outbreak. Yet, 44 2 people died. [see comments for correction]

OK, people will say, that’s before good medicine and sanitation. (boggle boggle boggle). How about more recently? How about 1966, just as the vaccine was being rolled out (or, as the rejectionists would have it, just about the time when measles decided to coincidentally morph into a mild disease). The title of the piece in Time magazine? End Measles Now. Take a look at the opening paragraph:

To the casual observer, the heavy snow, gale winds and high tides that struck most of the Northeast last week seemed to have turned Rhode Island into a disaster area. Like homeless refugees, long lines of crying children clinging to their parents snaked through the gloom. But it was not the storm that turned out the Sunday crowds. Rhode Island was engaged in a well-planned exercise in preventive medicine.

Yes, people were braving huge storms to go out and get their kids vaccinated against measles. Why? People realized that measles was still, in advanced-medicine-good-sanitation 1966, a major problem.

All over the country concern about measles is increasing. At the research level, physicians and other virologists have long been puzzled about how and when the measles virus attacks the brain, as it does in an estimated 4,000 U.S. cases of encephalitis each year

1966: 4,000 cases of encephalitis every year.

How about 1977? Clean, advanced 1977? An Alarming Comeback for Measles.

Adds Dr. Colette Rasmussen of the Cook County, Ill., public health department: “Too often the disease is looked upon as a sickness all children once had, as a kind of joke.” Unfortunately, measles is no laughing matter. While the overwhelming majority of victims recover in a week to ten days, some develop pneumonia or encephalitis. If the measles virus spreads to the brain, it can cause convulsions, coma and brain damage, and sometimes death.

1977: People still scared of the measles. But, people are starting to forget how bad measles was pre-vaccine.

And, then there’s today. In a piece, How My Son Spread the Measles, Time interviewed the mother of the child who imported the measles from Switzerland this year. They couldn’t use her real name, so they called her “Jane”. She describes the situation:

Jane says she did not know her son had been exposed to the measles while visiting Europe; and she didn’t know that her son was infectious. She and her husband select vaccinations for their children based on their age, their body’s ability to fight the infection, and the risks of the vaccination. Her infected son was not inoculated against measles. “We analyze the diseases and we analyze the risk of disease, and that’s how my husband and I make our decision about what vaccines to give our children.”

She gambled not only with her son’s life and health, but with the lives and health of other children. Other children, including those too young to be vaccinated against measles. But, she does feel “horrible” for the other people affected:

She adds about the outbreak, “I feel horrible for those children and their parents, but I want to protect all children from harm. And so by making sure there is more research done, we can help all children.”

Vaccines in general are a good thing, she says, but the problem is in the ingredients. Many vaccines contain mercury, formaldehyde, and aluminum, Jane argues. Thimerosal, which contains a mercury derivative, was once a common preservative in vaccines, she says. “This just can’t be good for you. Injecting yourself with aluminum can’t be good.”

She weighed the known risks of measles (death, brain damage, pneumonia, to name a few) against the perceived risks of vaccines (with the vague: “Injecting yourself with aluminum can’t be good”). Not a very quantitative comparison. But, she can make this decision because:

Because her children are healthy and well-nourished, Jane said they will sail through childhood diseases such as measles and chicken pox without trouble — and get lifelong immunity from the exposure. And she said, because the U.S. is a relatively healthy first-world country with a well-functioning health care system, she feels safe in making the choice to vaccinate selectively.

Let’s take a quick look at how an actual measles survivor recalls the measles:

I’m in a hospital bed, gasping for breath. Through the clear plastic of an oxygen tent, I see my Mom. Her face is red and she’s crying and crying. I feel hot. Every few hours a nurse opens the oxygen tent and gives me a shot. It hurts.

It’s 1959. I’m in second grade. I’d caught the measles, just like my brothers and sisters and friends. Except unlike them, my measles didn’t go away. It got worse and turned into something I’d never heard of: pneumonia. I spent a month in the hospital, survived, and spent a few more months recovering at home. But more than four million children got measles in the United States in that year and 385 died.

He doesn’t mention poor sanitation or bad medical care. Yes, it was 1959, but that’s supposedly when measles was becoming a “mild” disease. Yes, modern medicine kept him alive. Want to bet what his chances would have been 50 years earlier?

But, let’s look back at how “Jane” made her decision:

“Looking at the diseases mumps, measles and rubella in a country like the U.S…. it doesn’t tend to be a problem,” Jane said. “Children will do fine with these diseases in a developed country that has good nutrition. And because I live in a country where the norm is vaccine, I can delay my vaccines.”

Yes, because the rest of us are vaccinated and we vaccinate our children, she can delay vaccinating her kids. Well, sort of. Evidence shows that in reality, her kid did get a vaccine preventable disease because she “delayed” the vaccine. (It is an open question in my mind whether he child was ever going to get the MMR, but let’s move on).

What are the real risks of the measles….today…in the United States? From the Atlanta Constitution Journal piece:

Along with the pneumonia I had as a kid (1 to 6 percent of measles cases), the risks of measles include severe encephalitis (one per 1,000 cases) — about a third of which result in mental retardation. They also include one to 10 deaths for every 10,000 measles cases. Another risk is subacute sclerosing panencephalitis, a rare fatal illness (one per 100,000 measles cases) caused by an ongoing measles virus infection of the brain, in which symptoms of brain damage usually begin seven to 10 years after infection.

“Jane” made a decision that put a dozen kids at risk of death or brain damage. The odds were in her favor, and they seem to be OK (if you can call taking an infant to the hospital, “OK”). “Jane” won’t know for seven to ten years whether her child, or any of the 12 he infected, will come down with subacute sclerosing panencephalitis (SSPE). At 1 in 100,000 , the odds are pretty good that they will all be OK. But, not zero.

But, let’s compare that to the real risk of MMR. Again from the AJC piece:

And the side effects of MMR? Fever, malaise, a mild rash, swollen glands and a stiff neck in about 5 percent of the patients, febrile seizures in about three out of 10,000, and temporary low platelet count in about three per 100,000 patients. About one in 1 million have an easily treated anaphylactic reaction. And no deaths. Not one.

Because of the relationship of the measles virus to encephalitis, vaccine safety experts have had an ongoing concern that the MMR vaccine might be a rare cause of this disease. Fortunately, all studies with controls have found no association between the MMR vaccine and encephalitis.

So, on the one hand (catching the measles), you have a 1 in 100,000 chance of death by SSPE, a 1 to 10 per 10,000 chance of death right away, about 0.3 per 10,000 chance of mental retardation. On the other hand (getting the vaccine) you have no deaths, febrile seizures in about 3 per 10,000, anaphylactic reaction in 1 per 1,000,000 and 5% with more mild symptoms. Yes, those are all real reactions. But, the balance is clearly tilted towards vaccination. Except, as “Jane” put it, “And because I live in a country where the norm is vaccine, I can delay my vaccines.” Yes, if others are protecting your child, you can “delay” vaccinating and, usually, get away with it.

Let’s do the comparison for “Outbreak Jane”, shall we? With about 10 people affected, the odds were roughly

0.3% that someone could have suffered brain injury
0.1 to 1% that someone could have died
0.01% chance that in the next 10 years one of these people will die of SSPE. Pretty low odds, but, that’s a lot of chips on the table. Would you be happy if someone made that bet for you or your child?

And, that last bit is important. “Jane” made the decision for other people. Some were people whose children were too young to vaccinate.

Still, Jane says she was surprised by the number of calls she got from friends who wanted to bring their unvaccinated children over to play with her kids while they were infectious. Like Jane, they see getting the measles as far healthier than the vaccine.

That’s just a googleplex of boggles.

She said the recent measles outbreak in her region prompted her to do more research. That work has made her even more certain that she and her husband are choosing wisely to be very selective about vaccinations. “This is a difficult choice for parents; choose the vaccine or choose the disease. I have chosen the disease by not vaccinating.”

She chose wisely? She chose “the disease by not vaccinating”? Yes, I agree, she did. The problem is, she also chose the disease for many people other than her own family.

Measles is far from mild. And, no, it isn’t as though people in the past thought so. They just accepted the sickness and death that inevitably came with measles outbreaks. Dr. Keily is quite correct in his piece on the AJC

My mother wasn’t wrong to be crying, back in 1959. The risks of measles are real. Americans were right to be elated when the measles vaccine became available.

The MMR vaccine doesn’t hurt kids. Letting them go without it will.

[note: some small changes have been made since this was first published. Most notably, I corrected a mistake where I put the odds of SSPE at 1 in a million, instead of the correct 1 in 100,000]

15 Responses to “The myth of mild measles”

  1. Sullivan October 9, 2008 at 02:03 #

    Note,

    “Jane’s” child was 10 years old. Not vaccinated against MMR. That’s not “delay”, that’s “rejection”.

    Consider this quote:

    The family’s planned travel to third-world countries prompted her to research other vaccinations. Her children are now vaccinated against tetanus, diphtheria, polio, Hepatitis B and typhoid fever because the risks of those diseases overshadow the risks of complications from the vaccines.

    It took a case of measles and the possibility of third world travel to vaccinate against tetanus? In my book, that blows the “she’s really self educated” argument right out of the water. Tetanus is a really nasty disease. It’s in the dirt in San Diego, not just the third world.

    Boggled. Uber-boggled.

  2. Ms. Clark October 9, 2008 at 05:52 #

    Sullivan,

    I’m glad you took the time to respond to the people (including a self-serving mom blogger) who have written that in the past measles was laughed at. The one blogger I’m thinking about produced as evidence to show that measles is really a big nothing a song by Frank Sinatra where he said something about having had the measles. She reasons back then measles was just something to laugh at because there were references to measles (and chickenpox) in popular TV shows and songs.

    I wanted to write my own blog article in response but didn’t partly because the the fact that this female was spreading the idea that measles is just a nothing disease made me so angry.

    Anyway, I wanted to say that there’s another song from the 1960’s, “Poison Ivy”. It’s a sort of goofy popular song, where a man warns other men to stay away from a woman named Ivy who has the nickname, “Poison Ivy.” You can tell it’s meant to be a silly song from one of my favorite lines in the song.


    “It’s gonna take an ocean,
    of Calamine lotion.” (I have this song on my iPod.)

    But here’s what the song says about childhood diseases.

    “Measles make you bumpy
    And mumps’ll make you lumpy
    And chicken pox’ll make you jump and twitch
    A common cold will fool ya
    And whooping cough will cool ya
    But poison ivy, Lord’ll make you itch!!”

    so what does “whooping cough will cool ya” mean?

    I think it means that “whopping cough will kill ya” since cool rhymes with fool and starts with the “K” sound, and if you die your body turns cold.

    So maybe that’s over-interpreting the lyric, but I don’t think so. Whooping cough kill many babies and if it doesn’t it can make them terribly sick and they can end up with brain damage from it. I suspect the authors of the “Poison Ivy” lyrics knew that. Whooping cough nearly kills a baby in “Anne of Green Gables,” but Anne saves the baby.

    So if they know it’s a deadly disease then why are they singing about it in a funny song? Because people do that sort of thing. It’s sort of like “whistling past the graveyard.”

    Another example is “Rocking Pneumonia and the Boogie Woogie Flu.” It would be hard to argue that the people who wrote those lyrics didn’t know that the Flu and Pneumonia could kill people.

  3. Baby Baluga October 9, 2008 at 06:31 #

    The one blogger I’m thinking about produced as evidence to show that measles is really a big nothing a song by Frank Sinatra where he said something about having had the measles.

    The same blogger asked “Were kids dying of measles in America when Leave it to Beaver was airing? ”

    Uh, the answer would be YES.

    Leave it to Beaver, I believe, aired 1957-1963.

    Let’s use a source that blogger might have checked had she cared to put out the minimum of effort. Even Scudamore (the Whale) lists deaths by measles during those years–ranging from 40-166 per year.

    I guess that’s no big deal? The likely much higher number of cases of disease induced mental retardation…no big deal?

    Yeah, people were driving around in storms to get vaccinated because, well, it was all one big joke. A party. Just ask the gentleman who wrote that piece for the Atlanta Journal Constitution. He was fighting for his life during the “Leave it to Beaver” age. But, since he lived, it’s a joke?

  4. Catherina October 9, 2008 at 08:28 #

    The SSPE rate is probably much higher than 1 in 100’000, as Bellini et al found in an analysis of SSPE cases after the 1989-91 epidemic in the US:

    http://www.ncbi.nlm.nih.gov/pubmed/16235165

    Stephan Arenz, a German epidemiologist, puts the incidence in children contracting measles under one year of age as high as 1 in 2’000.
    S Arenz Kinderärztl Praxis 77:29-31 (2006)

  5. maddox22 October 9, 2008 at 10:51 #

    The thing that really gets me about the “nutrition and sanitation” argument is Africa. These people really believe that good nutrition and sanitation–and not vaccination–are the reason that measles etc are not longer prevalent in the U.S., right? Have they never heard of vaccination programs in Africa (and in developing nations on other continents)? These are countries that have almost no nutritional or sanitary services–countries where millions of children die of diarrhea every year due to lack of sanitation, and millions more due to starvation–and yet, in the countries that have vaccine programs, almost NO kids get or die from vaccine-preventable illnesses. And yet these people still maintain that vaccines don’t prevent illnesses?!?

    How thick-headed do you have to be to ignore evidence right in front of your face??

    Oh, right. I forgot who I was talking about.

  6. Patrick October 9, 2008 at 14:06 #

    Very well said.

    If those folks were watching reruns of comedy shows they might need to stop and think a moment. Comedy is meant, in some cases, to bring levity to very serious situations the people of the time were dealing with. Even in some talk shows, humor can mask the serious issue.

    Certainly I hope nobody really thinks that WWII POWs were as happy as those portrayed in Hogan’s Heroes, but yet there it was within about 20 years after that war had ended. And what about Don Quixote? Classic opera with humor relating to the diseases of aging. Then consider modern acknowledgement of the impact of dementia like conditions on the rest of the family.

  7. alyric October 9, 2008 at 15:07 #

    That’s a very fine post, Sully and the correct antidote to a lot of nonsense being spread about the real risks of vaccines and the diseases they prevent.

  8. isles October 9, 2008 at 19:32 #

    Don’t forget this famous and heartbreaking measles case report:

    http://www.blacktriangle.org/blog/index.php?p=715

    It’s by Roald Dahl, entitled Measles: A dangerous illness.

  9. anandamide October 10, 2008 at 08:43 #

    Having a couple of older brothers, I caught measles as a baby – the doctor then decided (understandably) that vaccination was a bit pointless. Unfortunately, my immune system didn’t quite get the message, and at 7 I got infected again.

    Fortunately, it wasn’t too ‘bad’ – I’m still here, 20 years later. But I’ll never forget the pain, or the weakness, or the frustration of being so starvingly hungry but unable to eat. I’ll never forget my parents’ carrying my ragdoll body into the car to take me to my GP, who pushed me in through the back door and helplessly confirmed the diagnosis. And I’ll never forget the fear in my parents’ faces.

    When I was 14, the WHO predicted a possible measles outbreak in the UK; me and my peers were scheduled another vaccination. While my classmates got skittish about needles, I pushed my way to the front of the queue.

  10. Chris October 14, 2008 at 16:53 #

    Let’s scroll back to 1934. In a piece simply titled Measles, Time states:

    New York City’s Health Commissioner Rice warned parents to beware of measles as a “very serious malady,” but assured them that this is not a “measles year” in New York. In the first ten weeks of last year the city had 9.562 cases and 44 deaths, against 413 cases and two deaths for the same period this year.

    It wasn’t a “measles year”, as in, this wasn’t a big outbreak. Yet, 44 people died.

    You’ve got this a bit wrong – the 44 deaths referred to “last year” though it it’s stated whether that was a “measles year” or not. The “not a “measles year”” quote refers to “this year” – but there were still 2 deaths. Which, had there been a vaccine, would have been completely preventable.

    However, this is only a small nit-pick.

  11. Sullivan October 14, 2008 at 18:20 #

    Thanks for the correction!

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