Measles is a bad disease. Or is it? When I was a kid, before there was a vaccine, I had it. I was sick, but was not hospitalized and did not die. Neither did my sisters. Neither did anyone I know. Should I conclude from this that it is not a bad, or dangerous disease? If I did, I would be either willfully ignorant or a moron. Or maybe just unable to understand that my family and the people I know are not a sufficient sample. Or how bad the outcomes can be, including hospitalization and death.
The CDC data is that in the US the hospitalization rate for children with measles under 5 years old is 17-18%, and for those 5-19 it is 4-6%. Of every 1000 children who get measles, 1-3 will DIE, despite medical care. Apparently, those odds are ok for many Americans, who do not vaccinate their children against measles. I sometimes think that the only good thing that might come from the ubiquitous betting industry (which didn’t exist legally in most places and certainly didn’t sponsor most sporting events on TV when I was a kid, or for most of my adulthood!) is that more folks might understand odds. But when you take on any risk, in addition to how likely something is to occur (what are the odds of the Bears beating the Seahawks?) you also have to consider how bad the outcome is. If the Bears lose, that is sad for me, and if I had bet on it I could lose money, but on the other hand it is good for Seahawks fans. The outcome of a child dying from measles is very bad, and I can’t think of anyone, from Chicago or Seattle, who thinks it isn’t.
Nonetheless, this year the CDC has reported over 5,000 cases of measles. Using the data above that translates into (depending on the age of the children) 200-900 hospitalizations and 5-15 deaths. Is it ok as long as one of those deaths is not in a child you know? Or if it is? It is true that for thousands of years before the measles vaccine was introduced in 1963 children died of measles, in far higher numbers that they do today, because there was not the kind of medical care that we have, and the world and its people survived. But there were a lot of very sad families. And if you had told them that now there was a shot you could get that would protect your children, they would weep with joy because others might not die.
But we now have measles epidemics, and it is because parents do not vaccinate their children.
I leave that as a self-standing paragraph, just to make it clear what the reason for the epidemic is. Measles is very contagious. More than almost any virus. Essentially 100% of susceptible people (those who haven’t had measles before or been vaccinated against it) exposed to someone with measles will get it. The word for this is infectivity; measles is almost 100% infective. Of those who get it, almost all will get sick because measles is also almost 100% pathogenic. (Contrast this, say, to polio. It is also about 100% infective, but only about 10% pathogenic; only 10% of those infected will get sick.) And of those who get sick some will be hospitalized and some will die (see above).
Do I think that those parents who do not vaccinate their children against measles (and other infectious diseases) want them to get sick and maybe die? No. But they are scared. They believe that there is risk from the vaccinations themselves and kids don’t like to get shots. Of course, neither did I but it didn’t discourage the parents of my cohort from getting us immunized, first against polio in the 1950s when the 1952 outbreak was very fresh in their minds and they were reminded of it by their friends in wheelchairs, and later against measles, mumps, and rubella. There are reactions to the vaccine, usually minor, to vaccines but they are nothing compared to the disease.
What about “living healthy” as a way of preventing disease, eating right and exercising, as promoted by a certain Secretary of Health and Human Services? Both are good ideas, and it is almost certainly true that the death rate from measles and other infectious diseases among those who contract them is lower than it was in previous centuries because of better nutrition among children. But while being better nourished is good, and can decrease the rate of hospitalization and death from these diseases, it is not anywhere near as effective prevention as the vaccines.
Vaccinate your children against everything that you can, except in the rare cases where your child has had a specific serious reaction (not a little pain or swelling) to a previous vaccine of the same sort. Or if they are severely immunocompromised in the case of live-virus vaccines such as measles or oral polio (which is rarely use in the US any more). It is the right thing to do for them, and for the rest of us.
And, while we’re at it, get your flu vaccine every year. And make sure your parents do. And be up-to-date on your Covid vaccines, especially if you are elderly. The exceptions would be people with very serious life-threatening reactions to a previous flu vaccine (like Guillain-Barre syndrome). And kids need it also; so far the flu season is just starting and kids have died. One, this week, 3 in the season, and probably there will be about 200 (if this is a typical year). Your child should not be one. Actually, no one’s child should be. The exceptions should not include thinking you are not at risk. We all are, and the older and more immunocompromised we are (flu is not a live virus vaccine) the more at risk we are. CDC estimates 5,000-50,000 deaths per year from influenza in NON-pandemic years, and 100,000 or far more in pandemic years. And the most vulnerable are the elderly and those with chronic diseases.
So short answer: Vaccines are GOOD. If you and your family members do not have a specific contraindication to a specific vaccine, get them. All. There is a word for people who say you shouldn’t, and it isn’t stupid. It is “wrong”.
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