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January 12, 2001
The Next Epidemic

hree-year-old Jason* returned home from overseas with an unexpected souvenir. Jason, who had missed some of his immunizations, arrived back home in California with a fever and a red rash. He was diagnosed with measles. Jason was the fourth case for the San Francisco Bay Area in 2000, and the health department diligently tracked all the people he had stayed with since his return home. Luckily, he didn't infect anyone else. If he had, it could have been the start of an epidemic.

Room to Grow


By Lisa M. Asta, M.D.

Sometimes I worry it just might take an epidemic to remind parents how important vaccinations are. Now that we are a generation away from regular epidemics of small pox and polio, some people have become complacent about the importance of immunizing children. Media stories often hype the exceedingly small risks associated with vaccines without mentioning the substantial benefits of immunization. Confronted with this biased barrage, concerned parents may chose to forgo one of the most important forms of protection that they can give their children. And as a result, their children are at a greater risk of bacterial meningitis, whooping cough, and measles.

It's wrong to assume that infections like measles have disappeared. The World Health Organization reported 1.1 million measles deaths in 1995. Forty years ago, the United States saw approximately 3 million to 4 million cases of measles and an average of 450 deaths from measles each year. In 1999, more than 93 percent of American children were immunized against measles, which explains why there were only 100 cases of measles and no deaths in 1998. Most of the measles cases in the United States are imported, like Jason's.


Confronted with a biased media barrage, concerned parents may chose to forgo one of the most important forms of protection that they can give their child: vaccinations. And as a result, their children are at a greater risk of bacterial meningitis, whooping cough, and measles.


I don't want to live through a measles epidemic like the one I saw in the late 1980s and early 1990s in Philadelphia. Nine children died of measles because their parents didn't believe in immunization, and many others were infected as a result.

Researchers have estimated that unimmunized and underimmunized children are 35 times more likely to get measles than their immunized classmates. Where I practice in California, about 0.5 percent of children entering kindergarten every year are not fully immunized. These children subsequently put their friends, siblings, and classmates at risk, because no vaccine is 100 percent effective in every recipient. So when unimmunized children bring measles and other infectious diseases into the community, the immunized children risk getting the disease too.

When unsubstantiated claims against vaccines lower immunization rates, epidemics occur. The United Kingdom saw 100,000 cases of whooping cough (pertussis) and 36 deaths when it temporarily suspended the DPT (diphtheria, pertussis, and tetanus) vaccine in the mid 1970s after unsubstantiated claims that it caused brain damage. If the equally unproven concern about the MMR (measles, mumps, and rubella) vaccine contributing to autism causes parents to refuse this important immunization, we will surely see deaths like the ones in Philadelphia needlessly repeated. And if we leave MMR behind, I'll start seeing babies born deaf because their mothers were infected with rubella during their pregnancy.

For our parents and grandparents, immunizations were the long-awaited result of vaccine research. Just a few decades ago, devastating infectious disease like small pox, polio, and whooping cough filled our cemeteries with victims. Through immunization, sanitation, and medical advances, families can have the often-cited 2.2 children and expect those children to reach adulthood.

I believe that parents who have access to truly scientific information (see recommended websites below) and a good pediatrician will continue to value immunization. It is these parents who are helping to stave off the next epidemic.

Names and identifying characteristics have been changed to protect the identity of the patient.

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Lisa M. Asta, M.D., F.A.A.P., is a board-certified pediatrician and a fellow of the American Academy of Pediatrics. Dr. Asta graduated from the Johns Hopkins University and Temple University School of Medicine. She trained at St. Christopher's Hospital for Children in Philadelphia, Pennsylvania. She is an assistant clinical professor of pediatrics at the University of California San Francisco School of Medicine. She practices in Walnut Creek, California.