Measles cases in the United States have surged to a new high, with more instances reported this year than any year since the disease was declared eliminated in the country in 2000.
This concerning spike coincides with a decline in childhood vaccination rates. Reports indicate that immunization coverage for diseases like measles, mumps, rubella, chickenpox, polio, and pertussis is decreasing in over 30 states, according to the US Centers for Disease Control and Prevention.
Some may think that being vaccinated means they are safe, but is personal immunity sufficient? As contagious diseases rise, what implications do these falling vaccination rates hold for public health? Are children solely at risk, or could adults face consequences too? Who bears the most risk in communities with lower immunity? And what steps can be taken to avert such potential issues?
To delve into these concerns, I consulted with Dr. Leana Wen, who is a wellness expert with a background as an emergency physician and former health commissioner of Baltimore.
CNN: Can falling vaccination rates lead to the resurgence of previously eliminated diseases?
Dr. Leana Wen: Absolutely. We’ve seen various examples globally. Countries that were once polio-free have had outbreaks due to disruptions in childhood vaccination programs marked by conflict. Measles outbreaks have surfaced in regions where the vaccine coverage has dropped.
Currently, the United States is facing a similar situation. In Texas, for instance, 753 cases of measles have been confirmed since January. According to the Texas Department of State Health Services, 98 of those cases required hospitalization, and tragically, two children have died. This outbreak appears to have originated in areas with low vaccination rates.
What if there’s an even further decline in childhood vaccination rates? A recent study published in JAMA indicated that a 10% drop in measles-mumps-rubella (MMR) vaccination coverage could lead to over 11 million measles infections over the next 25 years. If vaccination rates fall by 50%, the projections estimate 51 million measles cases, nearly 10 million rubella cases, and over 4 million polio cases.
The study also highlighted the severe outcomes of these diseases: potentially, 10.3 million individuals in the US could end up hospitalized, with over 159,000 deaths, and thousands more might experience paralysis or neurological complications due to measles.
CNN: Is this situation limited to unvaccinated individuals? Should vaccinated individuals be concerned if others are not?
Wen: Yes, they should be concerned for several reasons.
Firstly, while the vaccines offer strong protection, there is still a possibility of breakthrough infections. For instance, the MMR vaccine is about 97% effective against measles, which is a great level of protection, but it’s not perfect. So, even vaccinated individuals can be exposed and become infected. However, vaccination greatly reduces both the likelihood of infection and the severity of the disease if someone does contract it. The more prevalent the disease, the higher the chances of exposure.
Secondly, vaccine effectiveness may wane over time. As noted by the CDC, immunity against diseases like whooping cough diminishes a few years after vaccination. Older adults who received childhood vaccines long ago may find themselves vulnerable if these diseases resurface.
Lastly, some people cannot get vaccinated due to specific medical conditions. For example, those with weakened immune systems might not be able to receive the MMR vaccine because it contains a live, albeit weakened, virus. Similarly, individuals with certain conditions may find vaccines less effective. These individuals rely on the community to maintain high vaccination rates to minimize disease spread.
CNN: What about pregnant individuals? Are there vaccines they can’t have?
Wen: Yes, that’s an important point. Pregnant individuals should avoid the MMR vaccine because it contains live virus. Rubella is particularly hazardous during pregnancy.
Its effects can lead to miscarriage or stillbirth and may result in congenital rubella syndrome, causing birth defects like heart issues, brain damage, and more. Before vaccines became available, about 4 in every 1,000 babies born had this condition. Rubella continues to be a leading cause of vaccine-preventable birth defects.
Additionally, those who are pregnant should not receive other live vaccines, such as the varicella vaccine for chickenpox. It’s best to receive these vaccinations before pregnancy, as part of routine childhood immunizations. Others can also help by getting vaccinated to lessen the disease burden in the community.
CNN: Who is at the highest risk if overall immunity decreases?
Wen: I’d be particularly concerned about three groups. Firstly, newborns who are too young to be vaccinated are among the most vulnerable. Even mild illnesses that healthy adults might shrug off can be severe for them.
The second group includes immunocompromised individuals, like those undergoing cancer treatment or those on immunosuppressive medications. They are more likely to fall gravely ill upon exposure to diseases, and vaccines may not provide them with adequate protection.
Lastly, the elderly are at increased risk, as their age and any underlying health issues can heighten their susceptibility to severe illness. Combine that with potentially waning immunity from vaccines, and they face a serious threat if diseases become more common due to decreased vaccination rates.
CNN: What steps can we take to mitigate these risks?
Wen: Everyone should ensure they are up to date on their vaccinations by consulting their primary care providers. Parents ought to confirm this with their children’s pediatricians, while adults should check in with their family doctors as well.
This is vital for personal health protection. If booster doses are available, individuals should consider them, or simply understanding one’s health risks can aid in taking appropriate precautions.
Moreover, promoting community immunity is key. Each person’s efforts to prevent disease not only safeguard themselves but also protect those around them, particularly the vulnerable populations.
