Elliot Rubin, MD, FAAP
President, New Jersey Chapter, American Academy of Pediatrics
The advent of vaccines was the single most important public health advancement in the 20th century, following the 19th century improvements in sanitation and hygiene. Life expectancy dramatically increased from 50 years in 1900 to about 80 in 2010 due in large part to the reduction in mortality from infectious diseases.
The measles vaccine is a striking example of a vaccine success story. In 1912, 6,000 measles-related deaths per year were reported. In the 1950s, 3-4 million people per year in the contracted measles in the United States, with 400-500 annual deaths, 48,000 hospitalizations and 4,000 who developed encephalitis (brain inflammation) from measles. In the 1960s, measles vaccines were developed and perfected, and since then, the incidence had declined dramatically to actually being declared eliminated in the United States by the year 2000.
In 1989, the protocol for measles vaccination was refined to the current two doses. Since 2008, there has been a resurgence of measles in the United States and several outbreaks, not as a result of vaccine failure, but related to people travelling to the United States or returning to the United States with measles and spreading the disease to pockets of unvaccinated communities.
In 2014, there were over 600 cases, and so far this year, there have been over 120 cases, predominantly related to the Disneyland, California, outbreak that has spread to mostly unvaccinated people in 17 states, including New Jersey, with the most recent Jersey City case. Measles is now in our local communities. A person with measles is contagious four days prior to their symptoms, by droplets expelled from just breathing, that can persist in the air for up to two hours after the person has left the area. If you are exposed and susceptible, there is a 90% chance that you will develop measles. Children under one year of age who are too young for the MMR vaccine and others who are immunocompromised and cannot receive the vaccine are vulnerable and at risk for developing measles and its potential complications of pneumonia, deafness, brain damage from encephalitis and death.
In addition, the concept of herd immunity, whereby the background vaccination rate needs to be at least 94% of the population, comes into play and is necessary to protect those in the population who are the most defenseless – those not vaccinated or are too young or immunocompromised.
Evidence-based scientific studies have shown that vaccines work, are effective, and are safe.
With respect to the MMR vaccine in particular, numerous, reproducible studies have debunked any association with autism, after an initial assertion of a link that was based on a fraudulent study. It is imperative from a public health perspective that vaccine rates be kept above the herd immunity threshold. Failure to do so will result in more frequent and extensive disease outbreaks, with the potential for devastating outcomes affecting the children and other susceptible populations in New Jersey and elsewhere.
New Jersey has close to 9,000 reported schoolchildren – or 1.7% – who claim a religious exemption to one or more vaccines and thus are potentially susceptible to vaccine preventable diseases like measles. In the New Jersey Chapter of American Academy of Pediatrics alone, there are over 5,000 children – or 2.5% – with religious exemptions, with the highest percentages in Hunterdon, Monmouth, Sussex and Warren counties. That number is almost identical to the personal belief exemption percentage in California, where the current outbreak originated.
When it comes to public health and personal choice, it is best to keep in mind the oft quoted adage: “Your liberty to swing your fist ends just where my nose begins.” Personal decisions that affect only you personally (or those in your charge) may be open to debate, but they cross into another realm entirely when they affect your neighbor and her children.
We need to work together to find strategies to increase vaccination rates of our under-vaccinated populations in order to keep New Jersey from becoming the next outbreak hub. It is our duty and responsibility as medical professionals and community leaders to assure the health and safety of our most vulnerable populations and to keep them out of harm’s way.
Vaccinate your children!