Measles Is Serious (A History Lesson from My Grandmother)
Measles is back. The outbreak of this highly contagious viral illness that started at Disneyland in December has spread across the country and shows no signs of slowing. As of February 6, the CDC reported 121 cases in 17 states in this year alone, most linked to Disneyland. In 2014, we had 644 cases of measles in the U.S. This is a striking increase compared to the last 15 years, when we usually saw less than 100 cases in an entire year.
I’m sorry that so many people have been sickened in this outbreak and hope that it is reined in soon. This is no easy task given our mobile society and the fact that we like to congregate in places like Disneyland, schools, doctors’ offices, hospitals, airplanes, and shopping malls. Add to that the pockets of unvaccinated people where measles can easily spread, and we have a recipe for still more outbreaks until we can improve vaccination rates. In this situation, I particularly feel for those who can’t be vaccinated. Babies under 12 months of age and people who are too immunocompromised to get the MMR vaccine, like cancer patients receiving chemotherapy, are counting on the rest of us to get vaccinated and reduce the spread of this disease. Right now, we’re letting them down.
One positive outcome to this outbreak is that it has sparked lots more conversation about vaccines. It inspired me to be more public about proudly stating that our family is fully vaccinated. And I wrote an op-ed piece for my local paper, the Register-Guard, about the risk of measles in our community, given the low vaccination rates in our schools.
I spent a lot of time researching vaccines last year for my book. The result is an in-depth look at vaccine development, risks and benefits, and safety testing and monitoring. I also cover some specific vaccine concerns, like whether or not we give too many too soon (we don’t) and if we should be worried about aluminum in vaccines (we shouldn’t). (I don’t just tell you these things, though; I break down the science for you.) I read hundreds of papers about childhood vaccines, talked with researchers, and felt more confident than ever about vaccinating my kids on the recommended schedule.
There was one other bit of vaccine research that may have been the most meaningful to me: I flew to Florida to interview my grandmother, now 90 years old. She raised seven children before most of today’s vaccines existed. She was a mother during the 1952 polio epidemic that killed 3,145 and paralyzed more than 21,000 in the U.S. She was having her babies before a vaccine for rubella was available. That disease caused 11,250 miscarriages, 2,100 stillbirths, and 20,000 children to be born with birth defects in a 1964-1965 outbreak in the U.S.
My grandmother also nursed her children through the measles. Before the vaccine, nearly every child suffered through a case of measles at some point in childhood. During the current measles outbreak, I’ve seen some comments downplaying the seriousness of this disease. After all, most kids did survive measles without long-term consequences. However, many didn’t. Among those who didn’t survive was my grandparent’s second child, Frankie. In 1956, at the age of 6, he died of encephalitis, or inflammation of the brain, a complication of measles.
My dad was the oldest of my grandparents’ children and the first of 3 boys: Richard, Frankie, and Larry. When the boys were little, the family lived in a faculty housing unit at Princeton, where my grandfather was an English professor. The families that shared the building were a tight-knit community. They built a playground together and parents took turns keeping an eye on the kids. “It was such a marvelous place to grow up,” my grandmother told me. “There were a whole bunch of kids, and you knew every single parent. Had conferences about your children and so on.”
In May of 1956, all three boys came down with measles. My grandmother remembers neighbors remarking that they were lucky to get it all at once, although this wasn’t surprising given that measles is one of the most contagious pathogens on earth. Those infected are contagious for several days before the characteristic rash appears, and the virus can survive in respiratory droplets, suspended in the air, for two days.
The first symptoms of measles are like those of a bad common cold: cough, runny nose, achiness, fever, and often an eye infection. The itchy rash appears several days later and usually lasts for about a week. Despite the discomfort, my grandmother told me, “It was also a special time, when the boys got lots of ice cream and presents and stayed home and were amused and had books read to them. And the three of them were together.”
After about a week, the boys’ rashes started disappearing, and they appeared to be getting better. My grandfather had just been offered a position at Johns Hopkins, and he drove to Baltimore to look for a place for the family to live, while my grandmother stayed home to care for the kids. She remembers the night when Frankie’s case of the measles took a surprising turn for the worse:
“I settled all three boys down to bed. These were sick boys, but they were all getting better. They were recuperating quickly, and they were all on their way to being completely well. I got Frankie settled and got him his glass of water and then went to bed myself. But as I was getting ready for bed, I heard this kind of funny noise and went in just to check one last time. He was draped halfway out of the bed, which was strange, and I rushed over to pick him up and get him settled and realized that he was unconscious.”
My grandmother and a neighbor bundled Frankie up and took him to the hospital, but he never woke up again. As my grandmother remembers it, he was in the hospital with a coma for about a week before he died. She was at home caring for the rest of her children when she received a call from the hospital telling her she had better come in. By the time she arrived, Frankie had already died. The pediatrician who broke the news to her took my grandmother to her own home and put her in her guest bed to let the news sink in before she went home to tell Frankie’s brothers that he was gone. (I think that my grandfather must have come home by then, but my grandmother doesn’t recall exactly when. She does have a vivid memory of looking out the window, seeing the beat-up top of his car, and feeling a wave of relief that he was home.)
Frankie died of encephalitis, one of the cruelest complications of measles, estimated to occur in about 1 in 1,000 measles cases. Even today, with the best medical care, about 15% of those with measles encephalitis will die, and of the rest, 25% have lasting neurological damage. Children’s book author Roald Dahl described his daughter Olivia’s death from measles, also due to encephalitis that developed when she seemed to be getting better.
Frankie’s death was heartbreaking, and it came as a shock to my grandparents, but it wasn’t unusual. Before the introduction of the first measles vaccine in 1963, three to four million people caught the virus each year in the U.S. Of these, 48,000 people were hospitalized; 7,000 had seizures; 2,000 suffered permanent deafness or brain damage; and 500 died. One in 20 caught pneumonia and one in 10 got an ear infection. The incidence of complications due to the measles remains high today, too. In the current outbreak, about 25% of patients have been hospitalized.
These are not just numbers and statistics. Frankie was a spirited little blonde boy with a wide smile, and the measles stole his life, ending it at age 6. Just like my children and your children, his parents loved him beyond measure.
I asked my grandmother to tell me more about Frankie, and she reached back 60 years and remembered the time that Frankie and my dad, in kindergarten and first grade at the time, played hooky from school and wandered around Princeton town all day. She said they got in “mild trouble” for this mischief. She remembered how desperately Frankie wanted a pair of toy six-shooter rifles the Christmas before he died. (He got them, though my grandmother first tried to convince him to use a couple of sticks instead.) And she told me this simple memory of Frankie at a small amusement park in Maine:
“And he got on an ordinary merry-go-round, and it came around so he saw us again, and he turned around and just beamed, as though he was saying, “Isn’t this the neatest thing?!” But you know, I can still see his face, and that happy, happy smile.”
The development of the measles vaccine was an incredible public health achievement. It’s very effective, inducing immunity to the measles in 99% of people who receive the recommended two doses. After its release, the burden of this disease dropped dramatically.
The story is similar for other vaccine-preventable diseases (see graphs for each here). The introduction of each vaccine has resulted in a huge drop in disease incidence, along with all of the pain and suffering, health care costs, and lives that came with them. There’s a boatload of scientific evidence to support the safety and efficacy of every vaccine on the recommended CDC schedule, and I appreciate that science. Still, I think that one of the most compelling cases for vaccines comes from history. Vaccines have been so successful that most of our generation gets to live in the ignorant bliss of never having seen these diseases, much less in our own children.
We live in a privileged time. Just a few generations ago, our grandparents had no choice but to nurse their children through painful diseases, knowing there was a chance of serious complication and even death. Worldwide, measles still killed 122,00 people in 2012, mostly in parts of the world with limited access to the vaccine.
But here in the U.S., our generation of parents has a choice. We get to choose whether or not to vaccinate our children. And oh, how we treasure that choice. The trouble is that we’re so far removed from the pre-vaccine era that we can make the mistake of ignoring the stories of our grandparents and great-grandparents, stories of kids like Frankie. And we can make the mistake of believing that we make our choices in a vacuum. When we’re talking about infectious diseases, nothing can be further from the truth. Sure, a few can choose not to vaccinate, in addition to those who have a medical reason not to, so long as the rest of us do our part to maintain herd immunity. However, when too many make that choice, the disease regains its strength, and its first victims are often the most vulnerable.
I wrote most of this post while holding my 7-week-old baby boy. He is fighting his first cold right now. It’s just your run-of-the-mill cold virus, but his nose is filled with snot, and he has a sad little cough. I know he’ll be better soon, but I hate to watch him suffer. Mothers and fathers will always be nursing their babies through illness, but I’m glad to be a parent in the vaccine era, when herd immunity and my baby’s own immunizations can protect him from the worst of the world’s infectious diseases. Let’s hope we can keep it that way.