The understandable concern about Ebola has raised public awareness of communicable diseases, especially viral illnesses, and some of the challenges in treating them. And while Ebola is a terrible disease and is causing devastation in Western Africa, it actually poses very little threat to citizens of the US. Politics, unrelenting media coverage and the devastating nature of the disease have fed some of the unwarranted fears across the country and, more recently, here in Maine.
Ironically we tend to have a laissez faire approach to the communicable viral illness which actually pose a significant threat here at home, some of which are completely preventable but have been given new life because of poor healthcare decision making among significant parts of our population. Let’s review just a few.
Each year, on average, over 200,000 people will be hospitalized and over 30,000 people will die from influenza and its complications. The elderly are especially vulnerable but the very young and those with chronic diseases are more likely to succumb to influenza. It is a highly communicable disease which can largely be controlled through vaccinations and there are very few people who cannot receive the vaccination. There are dead virus vaccines (the shots), attenuated live virus vaccines (the nasal spray), and thimerisol free vaccines (although the safety of thimerisol as an antibacterial preservative is well established). Immunization is recommended for almost everyone over the age of 6 months and people age 2 to 49 who have healthy lungs can receive the nasal spray form of vaccine. In fact, the American Academy of Pediatrics is recommending the nasal spray for children age 2 to 8 who do not have asthma or other lung disease. Pregnant women should receive the injectable vaccine. Healthcare personnel have a special obligation to be immunized. Across the US less than 50% of healthcare personnel choose to be immunized and studies have shown that these personnel play a very important and costly role in transmitting the disease to vulnerable patients whom they serve. Alarmingly, generally healthy people can be infected with and spread influenza while having very limited or no symptoms. Universal immunization of healthcare personnel would go a long way toward reducing this risk.
More commonly known as Whooping Cough, pertussis is highly contagious and causes uncontrolled, violent coughing. It is especially troublesome in infants and children and in babies under the age of 1 it can be fatal. It can also cause very bothersome and persistent symptoms in adults. In the 1940’s, before pertussis vaccine was developed, this was a common disease. But the vaccine reduced the incidence of pertussis by more than 80%. However, beginning in the 1980s people began declining vaccination for their children and the disease is on the rise again, with over 27,000 cases reported in 2010 and a cases already reported in Maine this fall. We have also learned that the childhood pertussis vaccine requires and booster when we reach adulthood and this is now included as part of tetanus vaccine boosters.
When I was a child most children developed measles and were required to be quarantined until they were no longer infectious (I remember missing Thanksgiving when I was 5 because I was isolated in my room with the disease). Prior to the development of the measles vaccine in 1963 there were over 500,000 cases a year in the US and over 500 deaths from the disease. Measles was almost eradicated in this country until, again, people began refusing the vaccine for their children, this time due to concerns about the vaccine being linked with autism. In fact there was never any evidence of a link and the researcher who promoted the concept has since admitted that it was fraudulent. But the damage has been done. So far this year there have been 18 measles outbreaks in the US and over 500 cases.
We do have a viral disease success story. Polio was one of the most devastating diseases of the 20th century. An outbreak in the US in 1916 killed over 6000 people and left 27,000 people paralyzed. But a world wide effort has been undertaken to eradicate polio and through widespread polio immunization that effort is nearly complete. As recently as 1988 there were over 300,000 cases of polio worldwide. In 2013 there were only 407 cases, a 99% reduction in the incidence of the disease.