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An early cure for parents’ vaccine panic

By Seth Mnookin,

Almost exactly 15 years ago, top officials of the World Health Organization and the Centers for Disease Control and Prevention met in Atlanta to strategize for what would have been one of the most remarkable public health victories in history: the eradication of measles, one of the most infectious microbes known to humankind. By the mid-1990s, widespread use of the measles vaccine had halted transmission of the virus among residents of the United States and Britain. A CDC report noted that the major obstacle to eradication was that public and political support would wane as fears of the disease receded. There was no mention of parental concern that the measles vaccine might actually be harmful.

Today, that fear — specifically, a misplaced anxiety that the measles component of the measles-mumps-rubella (MMR) vaccine could cause autism — has become one of the main impediments to stopping the spread of the disease in North America and Western Europe. Last month, the CDC announced that 118 measles infections were reported in the United States in the first 19 weeks of the year. It doesn’t sound like a lot, but it represents a worrisome uptick, and it puts us on track to hit 300 cases in 2011, compared with an average of around 50 from 2001 through 2008.

Outbreaks have ranged from the Northeast to the Pacific Northwest, from the Gulf Coast to Southern California. Because of how easily measles can spread, attempts to contain even a single case can require enormous effort: On Wednesday, the Maryland Department of Health and Mental Hygiene announced that it was investigating whether a lone traveler to the state had exposed people to the disease at a grocery store, a liquor store, a high school graduation ceremony, an Applebee’s and a Baltimore Orioles game.

Since the autism-MMR canard was introduced by a British doctor named Andrew Wakefield in 1998, there have been dozens of studies by scientists around the world showing that it does not have any validity. But once fear is injected into a population, it can be difficult to eradicate, and some parents are still choosing to delay some vaccines and skip others altogether. For example, between 2005 and 2010, the rates of unvaccinated children doubled in New York and Connecticut and a recent investigation found 200 schools in southern California at risk for outbreaks because of the number of parents who were choosing not to immunize. That the concern about a possible autism-vaccine connection remains so pervasive makes clear that the efforts to combat this misinformation have been inadequate. We need to fix the way we teach parents about vaccinations — and one way to do that is to start before they actually become parents.

Three years ago, I began work on my book “The Panic Virus,” about the recent controversies regarding vaccines and autism. If there’s one thing I’ve learned, it’s that virtually everyone involved in this issue is frustrated. Pediatricians are exasperated at the amount of energy they spend addressing specious concerns, public health officials are discouraged by the rise of vaccine-preventable infectious diseases, and families who believe that their children were injured by vaccines feel forsaken by their doctors and their government.

But the most important players in this drama are expectant parents and parents of very young children. In many ways, they have the most legitimate reason to complain about the way they’re being treated. A recent survey found that 60 percent of parents actively sought out information about vaccine safety before their children were vaccinated, but typically the first time the topic comes up with a medical professional is when there is a needle in their pediatrician’s hands. The first several months of a baby’s life are overwhelming, exhausting and nerve-racking — not exactly the best time to process a lot of new information.

I know: Just as I was finishing work on the book, my wife gave birth to our first child. Throughout her pregnancy, we kept meticulous notes about every conversation we had with our health-care providers. We knew the difference between nuchal translucency screening and amniocentesis, and we knew the relative risks of various procedures, both nationwide and at the hospital we were using.

No such notes exist for the period after our son was born. By the time we showed up for his two-month checkup, I barely had enough energy to brush my teeth. That was when, in the midst of a 15-minute “wellness” appointment, our son was scheduled to receive vaccines that would protect him against rotavirus, pneumococcal disease, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, polio and hepatitis B. It’s true that there were signs in our pediatricians’ office stressing the importance of vaccines — but at no point did anyone broach the topic or offer to answer any concerns.

If, on the other hand, we had had a scheduled appointment before our son was born to discuss issues of infant health — such as the dangers of infectious diseases and the importance of vaccines — we would have written that information down and reviewed it when we got home. If we’d had questions, we could have discussed them at a time when we were able to actually process the answers.

At a prenatal appointment, with no baby to distract or soothe, parents could ask how vaccines work. They could digest the fact that, contrary to some rumors, vaccines are not injected directly into the bloodstream, they do not contain antifreeze, and there is no evidence that children receive “too many too soon.” They could discuss early warning signs for developmental disabilities and review the studies showing that there is no connection between vaccines and autism. They could hear about the dozens of infants who have recently been hospitalized with measles or have died of whooping cough. And they could learn about “herd immunity” — what occurs when enough people in a population are immune to a disease to prohibit it from being spread in the first place.

There are logistical hurdles to setting up this type of system, including the fact that for the most part, the obstetricians who treat pregnant women are not trained in pediatric care. But squabbling over treatment turf instead of looking for new ways to tackle the problem is short-sighted.

As we’ve been discovering, the costs of getting vaccine education wrong are potentially enormous. It’s too early to tabulate the costs of this year’s outbreaks, but recent studies have looked at two small-scale outbreaks in early 2008: one in Tucson in which 14 people were infected and one in San Diego in which 12children were infected. (All of those cases occurred in unvaccinated children or adults of unknown vaccine status.) Arizona’s outbreak ended up costing $800,000 to contain, and San Diego’s $200,000, figures that were obtained by adding up hospital and quarantine costs, among other expenses.

As recent history has shown, these figures can explode in an incredibly short time. In 2006 and 2007, France had an average of 40 measles cases per year. In the first five months of 2011, the country has recorded more than 10,000 infections, including 360 cases of severe measles pneumonia, 12 cases of encephalitis and six deaths. In 2008, Britain declared that the number of unvaccinated children was large enough to sustain the “continuous spread” of the disease — which means the victory that was celebrated 15 years earlier had essentially been reversed.

We have not yet reached that point in the United States. And talking about vaccines before a baby is born might be all it takes to ensure we never do.

Seth Mnookin , a lecturer in MIT’s Graduate Program in Science Writing, is the author of “The Panic Virus: A True Story of Medicine, Science, and Fear.” You can follow him on Twitter or read his blog at the Public Library of Science.

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