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America’s Vaccination Dilemma: Learning from the Swedes

The increase in U.S. measles cases is alarming because measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths world wide each year. The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 145,700 people died from measles in 2013 – mostly children under the age of 5, which is about 400 deaths every day or 16 deaths every hour. Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide. During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths, making measles vaccine one of the best buys in public health.  However, the once eradicated disease is making a comeback in the US due, in part, to reduced vaccination rates.  In some areas of California, 13 percent of young children have not been immunized. 

We can learn a lot from the Swedes when it comes to immunizations.  Americans appear to view vaccinations as an individual choice while Swedes willingly sign up for optional vaccines. In Sweden where vaccination coverage is estimated to include 95% of the entire population, there are no widely reported significant outbreaks.  Swedes show up for their immunizations as a way of providing herd immunity for people who cannot be vaccinated for medical reasons and are vulnerable to illness, out of a sense of civic duty.  The Swedish Institute for Communicable Disease Control emphasized that individual immunization, besides strengthening individual protection, was a way of protecting fellow citizens. While other factors such as travel patterns (tourism to and from many developing countries – particularly in parts of Africa and Asia) are also important to measles outbreaks, immunization is the key preventing disease and conferring community or herd immunity (see previous article on this term).

The anti-vaccination movement was fueled by a small case series report of twelve children in 1998 that interpreted or proposed a possible association (not causal linkage) between the MMR (measles, mumps, and rubella) vaccine and autism.  The study later proved to be flawed and was retracted.  Still misconceptions persist about the importance and safety of vaccinations. 

The CDC and other Public Health Services report the following facts regarding the US multi-state outbreak:

  • The United States is currently experiencing a large, multi-state outbreak of measles linked to an amusement park in California
  • From Dec. 28,2014 to Jan 28, 2014 to January 28, 2015, 67 people from 7 states in the U.S. (AZ, CA, CO, NE, OR, UT, WA), and 2 people in Mexico, have been reported to CDC as having measles related to this outbreak.
  • Some of them have been hospitalized
  • Most of them were unvaccinated; others did not know their vaccination status.  A minority of them were vaccinated.
  • Cases have occurred in people of all ages.
  • The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious.  However, no source has been identified.
  • Comparison of the genomic sequences from 9 patients for which information was available show that all 9 are identical to the measles B3 virus type that caused the large measles outbreak in the Philippines in 2014.
  • Currently Maryland does not have any measles cases associated with the multi-state outbreak and has not had a confirmed case of measles since 2013.
  • Historically, Maryland has had high measles vaccination rates.  Based on the DHMH Annual School Immunization Survey, an estimated 98% of kindergarteners had documentation of 2 doses MMR vaccine for the 2013 school year.  
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