Thursday, March 20, 2014

Vaccines and the Return of Preventable Illness

The New York City Department of Health recently issued a warning that there was an active measles outbreak in Upper Manhattan and the Bronx, and urged citizens to get measles vaccines if they were unvaccinated. If this had taken place several decades ago, it might not be out of the ordinary - occasional increases in infectious disease rates would happen and public health officials would renew their calls to parents to make sure their children were vaccinated. But in 2014, a decade after measles was declared eliminated in the US, an outbreak and the subsequent call for vaccination is out of place.

Measles has seen a surge in recent years, so much so that in 2013 there were 175 cases of measles, as compared to 60 cases in previous years. Figures don't exist for 2014 yet, but this outbreak in New York City is troubling. The measles vaccine became available in 1963, and the last great peak in measles incidence was in 1990. Prior to the vaccination becoming available, nearly every child in America caught measles, with several hundred dying from the illness every year and several thousand suffering severe symptoms, such as seizures and nervous system damage. Now, about 90% of Americans are vaccinated against measles.

So what then of this recent outbreak? Well, the suspicion has naturally fallen on increasing resistance to vaccination by those who are concerned about the potential dangers. The debate about a connection between vaccination and autism has been discussed to such a great extent elsewhere that I'm not going to venture into it here. Instead, I'm going to address the reasons people are concerned about vaccines, and the way we should approach these concerns. Regular readers of this blog will remember my past posts about vaccination (1, 2), so my opinion here should come as no surprise.

To kick it off, let me propose something. Let's stop using the term 'anti-vaxxer'. In dealing with parents that have concerns about vaccines, confrontational positions only serve to perpetuate the problem. As healthcare professionals, we know that vaccines are important and that failure to vaccinate has very serious personal and public health consequences. However, patients still have concerns. Firing these patients or labeling them as problematic only pushes these people out of the healthcare system and into a potentially dangerous situation. Compassion and concern are important with these patients, perhaps even more so than many other cases, and it's though compassion that we can keep them in our practices at least, and hopefully convince them of the importance of vaccination.

I also want to address the reason that people are concerned, because there's legitimate concern here. Put simply, people want to protect their children, and mandatory shots that make children scream and cry touch on that intrinsic desire. Unfortunately, vaccines have been a victim of their own success in this regard. In 2014, there is no imminent threat to speak of - these illnesses have largely been eradicated, and while American parents 50 years ago would gladly vaccinate their children to avoid measles, nowadays, their likelihood of a screaming child is higher than their likelihood of one with measles. Likewise, there's no apparent benefit either - as with all preventive medicine, if a vaccine works perfectly, absolutely nothing happens. As a result, they're a hard sell.

Even so, sell we must. For a treatment used nearly universally in America, vaccines have a massively strong safety record. And, unlike some conventional treatments, vaccines have proven remarkably successful as well. Despite major efforts in heart disease, cancer, diabetes, arthritis, and any number of other illnesses, none of these have been declared eliminated, while diphtheria, polio and smallpox (and until recently, measles) are considered illnesses of bygone era.

The recent outbreak, then, is not a call to arms to fight the 'anti-vaxxers' - it's an opportunity to welcome them back into our practices and again reach out to communicate with them, and at least to keep them under medical supervision.