While the uproar continues over a potential swine flu pandemic, there is a quiet controversy brewing about the return of an old disease that had once been nearly eradicated in the United States.
Last month, Maryland health officials said at least four people had been diagnosed with measles in Montgomery County - including an 8-month-old infant who contracted the disease in a hospital waiting room. Virginia officials were also warning that an infected Prince William County man may have exposed hundreds of people to the disease as he visited grocery stores and restaurants from McLean to the District.
Last year, 131 cases of measles were reported nationally, the most since 1996, according to the U.S. Centers for Disease Control and Prevention. In the first seven years of the decade, 63 cases were reported.
The rise could be an indicator that measles is making a comeback in the United States, said Paul A. Offit, chief of infectious disease at the Children’s Hospital of Philadelphia.
“This could be the sign of something bigger,” Dr. Offit said. “Do I think this is a trend? Yes.”
Dr. Offit said the U.S. may be seeing the crest of the vocal anti-vaccine movement, which has gained momentum over the past decade. The movement has been spurred by a feared link between vaccines and autism and the crowded vaccination schedule for infants and toddlers.
The vast majority of American children get the series of vaccines recommended by the CDC and the American Academy of Pediatrics against infectious diseases such as measles, mumps, rubella, polio and meningitis. More than 77 percent of American children get the full slate of vaccines, and fewer than 1 percent of children are going completely unvaccinated.
The CDC said that as of 2006, the most recent year numbers are available, 93 percent of American children had received the measles vaccine. The vaccine, which is given along with the mumps and rubella vaccine, is administered in two doses, one at 12-to-18 months and the other between ages 4 and 6. One worry for public health officials is that infants who have not yet been vaccinated - as was the case with the baby in Maryland - could contract the disease if the number of cases continues to rise.
Infectious disease experts say a vaccination rate of 95 percent is necessary to keep highly contagious diseases such as measles from becomine re-established in the United States. Vaccine rates are much lower in many countries, even developed European countries. As a result, measles is an ongoing public health threat that kills more than 250,000 people annually.
In this era of quick, global travel, that means yesterday’s outbreak in Macedonia could be tomorrow’s illness in Maryland.
“It’s simply a plane ride away,” Mark H. Sawyer, a pediatric infectious disease specialist in San Diego, said at a congressional briefing on vaccinations last week. “Many people have the impression it is not a serious disease, but it kills three out of 1,000 people who develop it.”
In the decade before the U.S. measles vaccine program began in 1963, an estimated 3 million to 4 million people in this country were infected annually. Between 400 and 500 people died, 48,000 were hospitalized and another 1,000 developed a chronic disability from measles-related encephalitis, according to the CDC.
All 50 states have vaccination laws for school entry. However, 48 states allow exemptions for religious reasons and 20 for philosophical reasons.
“Personal beliefs are affecting people who do not share those beliefs,” Dr. Sawyer said.
Barbara Loe Fisher, co-founder of the National Vaccine Information Center, a Virginia-based nonprofit, said parents deserve the right to be fully informed of the potential risks of vaccines before consenting to the schedule prescribed by the CDC and AAP, which includes 36 shots by age 6, up from a recommended 10 in 1983.
“My advice is to become educated and understand the risks of vaccines,” said Ms. Fisher, who founded her organization in 1982 after her son experienced a severe vaccine reaction. “If you choose not to vaccinate, you have to understand the risks of disease. Unfortunately, we are polarizing and dumbing down the entire vaccination process. We need a more balanced and informed approach. If doctors were as concerned about vaccine reactions as parents are, a lot of fear, anxiety and anger would be taken out of the dialogue.
“We have gotten into a mind-set where there is an abject fear of disease,” Ms. Fisher said. “In the ‘50s, everyone had measles and mumps, and there wasn’t this drama attached.”
Dr. Offit said there was, indeed, drama 50 years ago - more than 100,000 children were hospitalized and 500 died annually of those two diseases alone.
“The ones who are talking about how everyone got those diseases are the ones who are still alive,” he said.
Most of the reported side effects of the measles, mumps, rubella (MMR) vaccine are fever, rash, stiff neck and febrile seizures.
In 1998, a study by British researcher Andrew Wakefield looked at 12 children with autism and suggested that the onset of their symptoms was linked to receiving the MMR vaccine. It was later discovered that Dr. Wakefield misrepresented some of the data.
But his findings had an impact. Measles vaccination rates in the United Kingdom dropped almost immediately. The current rate of full MMR vaccine coverage for British children is 77 percent. There were 1,348 cases of measles in the U.K. last year, up 36 percent from 2007. In 1998, the year Dr. Wakefield’s research was published in the Lancet medical journal, there were 56 measles cases.
In the past decade, at least 20 studies have shown no link between the MMR vaccine and autism. In February, a special federal court ruled in three test cases that there was no link between the vaccine and autism. Autism now affects one in 150 children in the United States, an exponential rise from a decade ago.
Court rulings haven’t dissuaded the growing anti-vaccine movement. In California, there are clusters of unvaccinated children, most of whom are from upper-middle-class neighborhoods where computer-savvy parents have done lots of Internet research on vaccine risks, Dr. Sawyer said.
“There is both good information and bad information out there,” said Dr. Sawyer. “It is very difficult to sort through what to believe.”
While studies have disproved a direct link between MMR and autism, many people want to further study the safety of individual vaccines, the effects of giving so many vaccines at once and biological complexities that could make individual children susceptible to long-term side effects.
Celebrity Jenny McCarthy - who contends vaccines led to her young son’s autism diagnosis - has been a vocal supporter of taking a closer look at vaccines. She and her boyfriend, actor Jim Carrey, are in the forefront of Generation Rescue, a nonprofit that urges delaying vaccines or spreading them out on an alternative schedule and continuing to press officials to study the risks of vaccines.
“What number will it take for people just to start listening to what the mothers of children who have seen autism have been saying for years, which is, ‘We vaccinated our baby and happened,’ ” Miss McCarthy wrote in her recent book “Louder Than Words.”
Mr. Carrey recently wrote in an editorial for the online Huffington Post that the financial interests of pharmaceutical companies and the CDC vaccination schedule are linked.
“With vaccines being the fastest growing division of the pharmaceutical industry, isn’t it possible that profits may play a part in the decision making?” Mr. Carrey wrote. “That the vaccine program is becoming more of a profit engine than a means of prevention?”
Amy Pisani, executive director of advocacy group Every Child by Two, said the vaccine schedule is a highly studied and scientific recommendation.
“The scheduling question makes me so angry,” she said. “It is there for a reason - to save your baby.”