William Penn Life, 2003 (38. évfolyam, 1-12. szám)
2003-12-01 / 12. szám
_____ HealthPage____________________ A forgotten foe returns A/leas/es outbreaks elsewhere could let disease take root here again by Victoria Stagg Elliott from www.ama.org Last January, a 24-year-old woman became feverish on a flight from the Philippines to New York and later broke out in a red rash. Diagnosis: measles. She has since recovered. But some public health officials have not experienced the same relief. Instead, they see this incident and a few others as sounding an alarm that this illness may re-emerge after years of decline. "It's a cautionary note," said Steve Cochi, MD, MPH, deputy director of the National Immunization Program at the Centers for Disease Control and Prevention. "Measles is always on our doorstep." One flight away Experts point out that there is an unsettling reminder offered by this case—the first of 39 reported to the NIP this year-as well as this past summer's large outbreak in the Marshall Islands. According to a September report in the CDC's Morbidity and Mortality Weekly Report, hundreds of people in this former American territory became ill and three died because of a possible importation of measles from Asia. Because the virus is endemic to much of the world, it may always be just one flight away. "The resurgence of measles is related to the influx of people who are not immune, and it's the imported Health Links To learn more about the measles and how to protect yourself and your family from it, log onto the website of the American Medical Association at: www.ama.org cases which pose the threat to the those people who are not vaccinated or have waning immunity," said Kurt Cullamar, MD, an internist and infectious disease specialist. He knows this truth firsthand because he happens to be the brotherin-law of the woman who became ill on the airplane. Fortunately, it does not appear that his sister-in-law transmitted the virus to anyone else. In the Marshall Islands' outbreak, though, the virus traveled as far as Hawaii and Guam. "Let Hawaii's experience be a wake-up call to the rest of the country about how closely we are connected to areas that have measles," said Paul Effler, MD, MPH, state epidemiologist at the Hawaii Dept, of Health. Maintaining vaccine coverage is key Europe is experiencing growing numbers of cases because of declining rates of immunization. Coverage has dropped so low in Great Britain that Dr. Simon Murch, the pediatric gastroenterologist who originally suggested that there might be a link between the measles-mumps-rubella vaccine and autism, wrote a letter to The Lancet stating that the purported link and related vaccine fears were unfounded while concerns about the illness were very real. "There is now unequivocal evidence that MMR is not a risk factor for autism.... [But] unless vaccine uptake improves rapidly, major measles epidemics are likely in the UK this winter," he wrote. For the most part, the United States has vaccination rates that likely would prevent measles from spreading widely. For instance, 91 percent of 3-year-olds have received one dose of MMR. This number jumps to 95 percent by the time children enter school. Still, according to the National Immunization Program, two-thirds of cases are imported or directly linked to importation, and measles is so contagious that experts believe only vaccination rates near 100 percent would entirely eliminate the disease from U.S. shores. "Importation is not going to lead to a large outbreak as long as we maintain the high vaccine coverage levels that we enjoy," Dr. Cochi said. "But we face that danger if we let our guard down." Protecting everyone And that's why clusters of illness become a concern, especially in areas of the country that may have less than optimal vaccination rates. In Montana, only 85 percent of 3-year-olds have received at least one MMR dose. Doctors say the kids sometimes slip by either because of parental objections or the chaos of life. Regardless, these young patients would be in jeopardy. "Our goal should be to approach 100 percent immunization, and if we're seeing a resurgence of measles, that is all the more reason that we should do that," said Kurt Kubicka, MD, president of the Montana Medical Association, and a family physician in Helena. But even those who follow the recommendations to the letter may be at risk. Some children may fall into an unprotected zone-too young to receive the shot, but too old to still retain their mother's antibodies. And although measles is generally thought of as a childhood disease, adults are also at risk. "The most important thing we can do right now is to reduce the measles burden in the rest of the world," Dr. Cochi said. "That will continue to lower the risk of U.S. citizens coming down with measles." Copyright (c) 2003. American Medical Association. All Rights Reserved. Willi« Pem Life, December 2003 5
