Measles Outbreaks Underscores the Critical Role of Public Health
By Amy Pisani
Last week, news hit regarding the investigation of several cases of measles in Boston spurred by an employee of the French Consulate who potentially infected two others; someone living in her building and a restaurant patron in the building where she worked. This week, a separate incident has been reported involving a resident of New Mexico who contracted measles while traveling through Europe. In this case, the infected traveler landed at Dulles International Airport in Virginia, traveled via bus to several locations throughout the District and boarded a plane at Baltimore/Washington airport en route to Albuquerque, New Mexico via another stop at Denver airport. In an effort to contain this disease, public health officials are once again being called upon to investigate the circuitous route taken by this individual who has exposed tens of thousands of people to a highly contagious infectious disease.
It’s important to understand that measles is caused by a virus that is spread from person to person through air particles such as through coughing and sneezing. The measles virus can even hang in the air and live on surfaces for up to two hours. As recently explained by a San Diego public health officer, measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. It is most infectious approximately 4 days prior to the onset of symptoms, which will include a high fever, cough, runny nose, and red, watery eyes (often called “pink eye”). A rash soon appears that generally shows first on the face then spreads to the rest of the body and lasts for five days to a week. Thirty percent of reported cases experience one or more complications. Historically, death from measles occurred in approximately 2 per 1,000 reported cases in the United States from 1985 through 1992, and 1 out of every 1,000 children who got measles developed a brain infection, with about 25% of those brain infections resulting in permanent brain damage.
While public health officials are spending significant time and money to track down this recent measles case, our country faces some of the largest budget cuts in recent history and the concern is that the President’s budget does not include an adequate amount of funding to ensure the proper immunization of children, adolescents and adults. Last year’s H1N1 virus serves as a poignant reminder of the necessity of a strong public health infrastructure armed with the tools to rapidly respond to outbreaks of disease that threaten the entire public. Vaccines have been hailed as one of the greatest achievements of the 20th century. It has been clearly documented that vaccines are also the most economical medical intervention available. For instance, for every $1 spent on the combined measles, mumps, rubella (MMR) vaccine, $26 in medical costs are spared. DTaP vaccine has a similar savings record, with every $1 spent saving $27 in costs. The entire vaccine schedule for children is estimated to save 9.9 billion dollars in direct costs and 43.3 billion dollars in societal costs over the lifetime of a single-year birth cohort. Multiply this by the annual birth cohort (the total number of children born each year in the U.S.) and the savings become exponential.
Certainly the budget deficit requires tough decision making by Congress and while there are innumerable public programs that will be cut, from a clearly economic perspective, vaccine expenditures ultimately save money and therefore should remain off the cutting block. Vaccines are dissimilar to other medical and social interventions in that they are administered to the entire population in a series of doses which then infer a lifetime of immunity against diseases that threaten the entire public. In comparison, other medical and social interventions are designated for smaller subsets of the population and require continual administration in order to be effective. While no medical intervention can be classified as being 100% effective, vaccines clearly sit at the top of the medical pyramid in the effectiveness category. Vaccines are the quintessential public health intervention.
The mission of the public health departments will not change. They are tasked with protecting the health of the public, despite their many ongoing challenges such as hiring freezes, budget cuts, vaccine shortages, public mistrust of vaccines, and outbreaks of disease. Additionally, misinformation about the safety of vaccines, such as MMR vaccine, has resulted in parents declining or delaying vaccination, thereby leaving infants vulnerable to diseases that are often thought to be a thing of the past. Although the myths regarding the safety of MMR vaccine have been debunked through diligent research worldwide, health departments must continue to conduct costly outreach to re-educate a public that has been lulled into believing that the vaccine can do more harm than the disease it prevents.
In recent years measles has spread in areas including Southern California, Boston, Maryland, Virginia, DC, Pennsylvania and New York and today we see another case where tens of thousands of people may have been exposed from one infected person traveling through the US from the UK. And the threat is not just from measles. Right now, our country is in the midst of one of the largest outbreaks of whooping cough in nearly half a century. These diseases do not discriminate. There are no healthy living strategies, compared to those recommended to reduce the chances of heart disease and diabetes, that can protect an unvaccinated individual from a vaccine-preventable disease once exposed. This is why it is critically important to ensure the timely immunization of all of our citizens.
The President’s fiscal year 2012 budget calls for vaccine funding that falls nearly $123 million short of the needed funds. Funding for health departments to keep the public safe from deadly diseases should be left intact. If you would like to help remove financial barrier to immunization, then check out the efforts of the 317 Coalition. The 317 Coalition advocates for increased federal funding for immunization and focuses on implementing the polities of the Advisory Committee on Immunization Practices and other relevant policy. Your voice matters in this public debate, so we encourage you to help us support immunizations and public health.