There are diseases that we may never see in our lives, anymore, thanks in large part to vaccines. While these diseases may ravage poorer countries that lack the resources and infrastructure to provide a high level of immunization, such as the Philippines, those who live in affluent countries seldom see diseases that were once a common occurrence, let alone deaths from those diseases. This leads to a measure of complacency. Those of us who suffered through vaccine-preventable diseases all too easily think that it was nothing. After all, we made it. We forget, however, those who weren't so lucky, those who are no longer here to tell their story. So it is that we think of diseases like measles as no big deal. We think that it's only dangerous for people "over there".
Unfortunately, measles does not care what we think. It doesn't recognize borders. It doesn't care if you're from the United States, Germany, the Philippines, Pakistan, Nigeria, Brazil. It will infect wherever it can. And it will kill without a care about who you are or what you believe.
It is not uncommon to hear someone on the internet claim that measles isn't dangerous. They will say that we haven't had any recent measles deaths in the U.S. They might argue that the last measles death was in 2003, even though a woman died in 2015 due to measles pneumonia. They may try to convince others that the lack of measles deaths is because the disease has become less serious on its own, and that vaccines have nothing to do with it. Often, they will trot out a graph that shows how measles mortality was decreasing before the vaccine was introduced. Sometimes they'll try to claim that mortality (dying from a disease) is just an extreme version of morbidity (getting sick with a disease), perhaps like a doctor who has lost his license recently said:
As a consequence of natural Herd Immunity, in the developed world measles mortality had fallen by 99.6% before measles vaccines were introduced. A fall in morbidity will have paralleled the fall in mortality (mortality is the extreme of morbidity).What they do not note, however, is that the mortality rate never dropped below about 1-2 per 1,000 cases to 1 per 3,000 cases, nor do they note that the total number of cases (morbidity) didn't drop until the vaccine was introduced. They will also generally not mention that the "no deaths since 2003" figure represents only lab-confirmed measles deaths. That figure leaves out deaths due to measles that were diagnosed clinically, but did not meet the CDC criteria for lab confirmation. Nor does the figure include deaths due to subacute sclerosing panencephalitis (SSPE), a rare, universally fatal, complication of measles.
Before we get into all of those other deaths, let's take a look at just the lab-confirmed measles deaths. We have two in 2003 and one in 2015. From 2003-2015, there were 1,846 cases of measles in the U.S., giving us a mortality rate of about 1.6 deaths for every 1,000 cases. This doesn't differ much from the mortality rate around the time the vaccine was introduced. The picture changes, somewhat, when we include data from death certificates.
The National Vital Statistics System provides a wealth of additional information on births and deaths in this country. Accessed via the CDC's WONDER database, anyone can look up data on the underlying cause of death, with the caveat that the recorded cause of death reflects the physician's best clinical judgment. It can then be grouped by a variety of criteria, letting users slice and dice things to a great level of detail. We could see how many people died of a particular disease or disease complication, what year they died, what the age distribution was, and so forth.
Once we delve into these death records, we see that there have been more deaths than just the three noted above. For the same 2003-2015 period, NVSS shows 9 deaths from measles with or without complications (it only shows 1 for 2003; this may be because the other death was reported using a non-measles ICD code). There were also 20 deaths due to SSPE in the same period. In fact, if we look at the entire span covered by ICD-10 codes (1999-2014), we get a much grimmer view of this easily preventable disease:
|Click to enlarge.|
Source: CDC WONDER Database, Detailed Mortality
|Note: The 2003 total only includes data from NVSS. |
CDC confirms there were two deaths that year.
The next time you see or hear someone saying that measles "isn't that bad", remind them that it still kills a fair number of those it infects, even in the United States. Show them these numbers. Remind them that it does more than kill. It also disables. It makes them more vulnerable to other diseases. Even those who are not permanently injured can still spend time in the hospital receiving supportive care. And if they advocate getting immunity "the natural way" (i.e., by suffering through an infection), possibly even recommending hosting a measles tea, do your best to steer them away from such orgies of death. They can achieve immunity without the disease, and without being medically negligent, thanks to vaccinations.
- Centers for Disease Control and Prevention. (2015). Complications of measles. Retrieved June 30, 2016 from http://www.cdc.gov/measles/about/complications.html
- Centers for Disease Control and Prevention WONDER Database. Compressed mortality, 1979-1998. National Vital Statistics System.
- Centers for Disease Control and Prevention WONDER Database. Detailed mortality, 1994-2014. National Vital Statistics System.
- Centers for Disease Control and Prevention. (2004). Epidemiology of measles -- United States, 2001-2013. Morbidity and Mortality Weekly Report. Retrieved June 30, 2016 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a3.htm
- Centers for Disease Control and Prevention. (2009). Summary of notifiable infectious diseases and conditions - United States, 2007. Retrieved June 30, 2016 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5653a1.htm
- Centers for Disease Control and Prevention. (2015). Summary of notifiable infectious diseases and conditions - United States, 2013. Retrieved June 30, 2016 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6253a1.htm
- Herriman, R. (2015). Philippines measles outbreak 2014: 58,010 cases, 110 deaths. Outbreak News Today. Retrieved June 30, 2016 from http://outbreaknewstoday.com/philippines-measles-outbreak-2014-58010-cases-110-deaths-31292/
- Mina, MJ, Mercalf, CJE, de Swart, RL, Osterhaus, ADME, & Grenfell, BT. (2015). Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science, 348(6235), 694-699.
- NHS. (2015). Measles outbreak: what to do. Retrieved June 31, 2016 from http://www.nhs.uk/conditions/vaccinations/pages/measles-outbreak-advice.aspx
- Shapiro, H & Weir, E. (2001). Measles in your office. Canadian Medical Association Journal, 164(11), 1614.
- U.S. National Library of Medicine. (2014). Subacute sclerosing panencephalitis. Retrieved June 30, 2016 from https://www.nlm.nih.gov/medlineplus/ency/article/001419.htm
- Washington State Department of Health (2015). Measles led to death of Clallam Co. woman; first in a dozen years. Retrieved June 30, 2016 from http://www.doh.wa.gov/Newsroom/2015NewsReleases/15119WAMeaslesRelatedDeath