Thursday, August 30, 2012


Just a short measles miscellaneous of the day. I often come across the notion that it is "immigrants" that re-import vaccine-preventable infectious diseases to the US and that therefore, areas with a high number of immigrants have the highest risk of such diseases. Doctors apparently (achtung: hear say) also like to use that claim to encourage reluctant parents to vaccinate. Two notices appeared on my google feed a couple of days ago:

An 18-month-old girl and one-year-old boy died of measles pneumonitis in Darpa Khel area of tehsil Miranshah, said Agency Headquarters Hospital Miranshah MS Dr Muhammad Sadiq, adding that 25 more people are admitted at the hospital.
The outbreak of measles started in April across the Agency. Sadiq said that in the past week many patients have come from Darpa Khel and Madakhel because the localities have major sanitation problems. “We started vaccinating children but the disease resurfaced after a gap of one month,” he said, adding that most of the vaccines provided by the government have expired because of high temperatures and prolonged power outages.
The pediatrician said that most of the patients at the hospital were shifted from Khost, Afghanistan. “The Pakistani government could not vaccinate children from Afghanistan and when the epidemic broke there, patients came to Pakistan for treatment, infecting children here.”
These children are not going anywhere. They will get sick and many will die, right where they are, stuck in the middle of nowhere between Pakistan and Afghanistan (or an equally remote place). They do not have the money to make it to the US. So you guys are safe, right? Wrong: the below are the typical import situations:

LITTLE ROCK, Arkansas (AP) - The Arkansas Health Department says three siblings have been diagnosed with suspected measles and unvaccinated students at a northwest Arkansas boarding school where two of them are students have been sent home.
The agency said Tuesday that one of the siblings had recently traveled to Romania, Italy, and Switzerland. The youth's two siblings became ill while attending Ozark Adventist Academy near Gentry. (my bold)

VoilĂ  - import of measles into the US is essentially a (white) upper middle class problem. Unvaccinated children, exempt from vaccines at their posh fee paying schools, travel to European countries with very high measles incidence (Switzerland has been battling with measles for years, Romania has been the source for US imports before, too), bring measles back to the US and spread it to their siblings and peers (equally unvaccinated). Interestingly, an analysis of vaccine exemptions in Arkansas has just been published, reporting that since the introduction of the possibility of a "philosophical exemption" from immunization requirements in 2003, exemption rates have increased by 23% per year. There has been a drop in medical exemptions at the same time, calling into question the validity of these before the law was changed, however, the overall increase is still striking:

 Even more striking is the authors' prediction (as published in June 2012):
The increases in philosophic exemptions in Arkansas raise concerns that outbreaks of vaccine-preventable diseases may occur in the future.
Outbreaks of vaccine preventable diseases in the United States are very much a "first world", leisure travel-associated problem and therefore, entirely preventable. Check your vaccination status before you travel abroad!


  1. Spot on Catherina: I am so sick of hearing the bogus claim that it is the "foreigners" who bring these vaccine-preventable diseases to the United States.

    A small part of my work experience as a public health nurse was seeing patients in several of our satellite clinics. Our pediatric patients were first generation Americans whose parents were born and immigrated from Latin America, Asia and Africa. Their moms and dads were exceptionally compliant with "well child" clinic appointments; these children were almost always immunized completely and in a timely manner. The parents always called for appointments to get their children "caught up" on their immunizations. Perhaps these parents *knew* a lot more about the benefits of having their kids immunized according to the Recommended Childhood Vaccine Schedule?

    When I returned to my office at the health department to do case surveillance on individual cases or outbreaks of vaccine-preventable diseases, I found with trace-back investigations that (white) upper middle class kids were the index cases. These kids were deliberately not vaccinated, traveled to endemic countries and brought back the diseases, to infect other kids in their "group".

    BTW, an infant who is 6 months of age and not yet one year old, should receive MMR vaccine in contemplation to visiting a measles endemic country. This immunization will not be "counted" and when the child is one year of age (s)he will require the 2-dose MMR series.

  2. The US is becoming too willing to blame all of woes on immigrants and it kind of scares me. People all the time are trying to equate different things with Nazi Germany and most of the time I think it is just it is extreme paranoia or fear tactics. Blaming one group of people for everything that goes wrong though, that is hitting a little too close to the mark for me.

    1. It is despicable when they claim measles is coming from Mexico, when they have an excellent immunization program with 98% coverage for measles vaccine.