Quotes on Measles
Measles
The startling mortality
among children from the little-regarded ailment of measles was indicated to-day
by a statement issued by the State Department of Health, showing that in 1906
there were 1,463 deaths from it, 1,240 being of children under 5 years of age.
In December alone 2,807 cases of the disease were reported, and a search of the
records shows that it kills 2½ times more children than does scarlet fever.
(“Measles Kills 1,463, And 1,240 Were
Children Under 5 Years—Pennsylvania’s 1906 Record,” New York Times, January 19,
1908.)
…measles accounted for 11%
of all deaths in Glasgow in the years 1807-1812.
Case fatality rates were
high. For example, during the years 1867-1872 in a Paris orphanage, the Hospice
des Enfants Assistés, 612 of the 1256 (49%) children who developed measles died.
(Clive E. West, PhD, “Vitamin A and
Measles,” Nutrition Reviews, vol. 58, no. 2, February 2000, p. S46.)
All of the old menaces like
typhoid
, smallpox
, measles, scarlet fever,
whooping cough
and diphtheria
have become minor causes of death. The
chance is very remote indeed that any of them will ever again assume sufficient
importance in the mortality tables seriously to affect the general death rate. (Dr.
Louis Dublin, “Better Economic Conditions Felt in Fewer Deaths,” Berkley
Daily Gazette, December 27, 1935.)`
Between 1850 and 1900, the
commonly recurring epidemics of cholera, smallpox, malaria, and typhoid were
gradually brought under control. During the next 50 years, gratifying victories
over such endemic diseases as tuberculosis, diphtheria, measles, and scarlet
fever were witnessed. These diseases were less dramatic than epidemics, but each
was among the leading causes of death before 1900. By the middle of the 20th
century, except for the 1918 influenza pandemic, death from infectious disease
in Western industrialized countries was no longer a major component of
mortality statistics. (Velv W.
Greene, PhD, MPH, “Personal Hygiene and Life Expectancy Improvements Since 1850:
Historic and Epidemiologic Associations,” American Journal of Infection Control,
August 2001, p. 204.)
Measles, scarlet fever,
whooping cough, and diphtheria—the principal communicable diseases of
childhood—declined 31 percent in the year, or from 4.2 per 100,000 in 1939 to
2.9 in 1940. Each of these diseases reached a new minimum in 1940, and all
except whooping cough had a mortality rate of less than 1 per 100,000. Only a
comparatively few years ago the death toll from this group of diseases was
serious, but it has now been reduced to a point where their complete
suppression may be expected. (Handbook
of Labor Statistics, 1941 Edition, US Department of Labor, pp. 396–397.)
Before the general
nutrition status of European children reached the high level it is today,
measles infection was some-thing to be feared…Even in the absence of a
vaccine, by 1960, notification of childhood measles in England and Wales was
only 2.4% and mortality fell to 0.030%, which is 1/200th of the 1908
Glasgow mortality rate. (Clive E.
West, PhD, “Vitamin A and Measles,” Nutrition Reviews, vol. 58, no. 2, February
2000, p. S46.)
In the majority of children
the whole episode has been well and truly over in a week . . . In this practice
measles is considered as a relatively mild and inevitable childhood ailment
that is best encountered any time from 3 to 7 years of age. Over the past
10 years there have been few serious complications at any age, and all children
have made complete recoveries. As a result of this reasoning no special
attempts have been made at prevention even in young infants in whom the
disease has not been found to be especially serious. (Vital
Statistics, British Medical Journal, February 7 1959, p. 381.)
Death from measles in
Britain is now unusual... Furthermore, in one-half of the deaths there was an
accompanying chronic disease or disability which in the majority was described
as a serious handicap. It is reasonable, therefore, to conclude that in the
past 30 years mortality from measles has been reduced to virtually the lowest
figure possible. ("Measles and
Measles Vaccination," British Medical Journal, July 11, 1964, pp. 72-73.)
The “good old days,” when
everything, in particularly human health, was supposedly better than it is
today, are a myth. The documented history of Western civilization describes an
endless and unromantic struggle with sickness and death, tragically high infant
mortality, and the premature death of young adults. Death-dealing epidemics
attacked helpless communities nearly as often as summer and winter came to pass,
and were followed every few years by major catastrophes. In Victorian England,
the average age of death among the urban poor was 15 to 16 years. (Velv
W. Greene, PhD, MPH, “Personal Hygiene and Life Expectancy Improvements Since
1850: Historic and Epidemiologic Associations,” American Journal of Infection
Control, August 2001, p. 203.)
The stenches from the
“horribly foul cellars” with their “infernal system of sewerage” must needs
poison the tenants all the way up to the fifth story . . . the well-worn rut
of the dead-wagon and the ambulance to the gate, for the tenants died
there like flies in all seasons, and a tenth of its population was always in
hospital. (Henry E. Sigerist,
Civilization and Disease, Cornell University Press, New York, 1943, pp. 38–39.)
The Tenement
House Commission long after-ward called
the worst of the barracks “infant slaughter houses,” and showed, by reference to
the mortality lists, that they killed one in every five babies born in them.
(Jacob A. Riis, The Battle with the
Slum, Macmillan, New York, 1902, pp. 23–25.)
While the larger cities
possessed handsome residential districts in which the streets were paved and
kept clean and the sewage was properly cared for, there was also crowded foreign
quarters, veritable hives of humanity lacking ordinary comforts and often even
necessities. New York in 1850 had 8,141 cellars sheltering 18,456 persons.
There, as in Boston, about a twentieth of the population lived in damp, dark,
ill-ventilated, vermin-infested underground rooms. By the end of the war [US
Civil War] fifteen thousand tenement houses had been built in New York, many of
them hardly more than “fever nests.” (Arthur
Charles Cole, The Irrepressible Conflict 1850–1865, A History of American Life
Volume VII, Macmillan, New York, 1934, p. 181.)
For millions, entire
lives—albeit often very short ones—were passed in new industrial cities of
dreadful night with an all too typical sociopathology: foul housing, often in
flooded cellars, gross overcrowding, atmospheric and water-supply pollution,
overflowing cesspools, contaminated pumps, poverty, hunger, fatigue and
abjection every-where. Such conditions, comparable to today’s Third World
shanty town or refugee camps, bred rampant sickness of every kind. Appalling
neonatal, infant and child mortality accompanied the abomination of child labour
in mines and factories; life expectations were exceedingly low—often under
twenty years among the working classes—and everywhere sickness precipitated
family breakdown, pauperization and social crisis.
(Roy Porter, The Greatest
Benefit to Mankind, Harper Collins, New York, 1997, p. 399.)
The manner in which the
great multitude of the poor is treated by society to-day is revolting. They are
drawn into the large cities where they breathe a poorer atmosphere than in the
country; they are relegated to districts which, by reason of the method of
construction, are worse ventilated than any others; they are deprived of all
means of cleanliness, of water itself, since pipes are laid only when paid for,
and the rivers so polluted that they are useless for such purposes; they are
obliged to throw all offal and garbage, all dirty water, often all disgusting
drainage and excrement into the streets, being without other means of disposing
them; they are thus compelled to infect the region of their own dwellings. (Friedrich
Engels, The Condition of the Working-Class in England in 1844, Otto Wigand,
Leipzig, p. 97.)
In manufacturing towns,
factory chimneys spewed soot, and everything was covered with dirt and grime.
Smoke was a major ingredient of the famous London fog, which not only
reduced visibility, but posed serious health risks. Refuse, including the
rotting corpses of dogs and horses, littered city streets. In 1858, the
stench from sewage and other rot in London was so putrid that the British House
of Commons was forced to suspend its sessions. (Thomas
F. X. Noble, Barry Straus, Duane J. Osheim, Kristen B. Neuschel, Elinor A.
Accampo, David D. Roberts, and William B. Choen, Western Civilization: Beyond
Boundaries, volume II, 6th ed., Wadsworth, Boston, Massachusetts, 2010, p. 579.)
...milk sold in Chicago
came from cows “fed on whiskey slops with their bodies covered with sores and
tails all eat off,” a circumstance which enabled the editorial critic to explain
“Why so many children die in Chicago.” New York’s milk supply was also largely a
by-product of the local distilleries and the milk dealers were charged with
the serious offense of murdering annually eight thousand children. (Arthur
Charles Cole, The Irrepressible Conflict 1850–1865: A History of American Life
Volume VII, Macmillan, New York, 1934, p. 181.)
The dead-meat markets
are contaminated by the carcasses of diseased animals from all sources . . .
in the City markets alone his inspectors seize from one to two tons of diseased
meat every week; and similar seizures, but to a less extent, are made in
butchers’ shops and slaughter-houses outside the City by Medical Officers of
Health and their assistants. In Edinburgh [England], Mr. Gamgee tells us that
100 to 200 diseased cattle are sold in the dead-meat market every week,
carcasses being smuggled in by night even from adjoining piggeries. In this way
the best butchers, in ignorance “may and do serve diseased meat to the
wealthiest in the land.” . . . Pigs are largely fed upon diseased meat which
is too far gone even for the sausage-maker, and this is saying a great deal; and
as an universal rule, disease pigs are pickled and cured for bacon, ham,
etc. (The British and Foreign
Medico-Chirurgical Review, Quarterly Journal of Practical Medicine and Surgery,
vol. XXXV, John Churchill & Sons, London, January–April 1865, pp. 32, 33.)
Children of all ages, down to three and four, were found in the hardest and most
painful labor, while babes of six were commonly found in large numbers in many
factories. Labor from twelve to thirteen and often sixteen hours a day was the
rule. Children
had not a moment free, save to snatch a hasty meal or sleep as best as they
could. From earliest youth they worked to a point of extreme exhaustion, without
open-air exercise, or any enjoyment whatever, but grew up, if they survived
at all, weak, bloodless, miserable, and in many cases deformed cripples, and
victims of almost every disease. (William
Franklin Willoughby and Mary Clare de Graffenried, Child Labor, American
Economic Association, Guggenheimer, Weil, & Co., Baltimore, March 1890, p. 16.)
In the
manufacture of glass . . . the hard labour, the irregularity of the hours, the
frequent night-work, and especially the great heat of the working place (100 to
190 Fahrenheit), engender in children general debility and disease, stunted
growth, and especially affections of the eye, bowel complaints, and rheumatic,
and bronchial affections. Many of the children are pale, have red eyes, often
blind for weeks at a time, suffer from violent nausea, vomiting, coughs, colds,
and rheumatism . . . The glass-blowers usually die young of debility or chest
infections. (Roy Porter, The
Greatest Benefit to Mankind, Harper Collins, New York, 1997, p. 401.)
It is not strange that
health improves when the population gives up using diluted sewage as the
principle beverage. – Dr. Thurman Rice, 1932
...to relieve the suffering
of the laboring classes in England, an improbable coalition of social activists,
prison reformers, physicians, clergy, and scientists started advocating sanitary
reform in the early 1800s. They maintained that both illness and poverty
resulted from “insanitary” conditions and practices that could be remedied.
This “sanitary movement” was instrumental in getting legislation passed in Great
Britain during the 1850s and 1860s to create public health authorities with the
power to regulate sewage collection, water supply, environmental nuisances, and
a remarkable list of other relevant matters, such as physician licensing and
child labor abuses. (Velv W. Greene,
PhD, MPH, “Personal Hygiene and Life Expectancy Improvements Since 1850:
Historic and Epidemiologic Associations,” American Journal of Infection Control,
August 2001, p. 205.)
The 1880s had been “the
dark, desperate, impossible decade,” with widespread malnutrition among the
working class. In the 1890s, people had better opportunities for improved
nutrition—not only because there was more money for food, but also because women
could stay home to cook... From the 1890s, the principles for governing the city
changed from being purely economic to including concern for the health of the
population. A “sanitary police” department was instituted as part of the new
emphasis on improvements in environmental hygiene. This authority was charged
with inspecting food and milk and checking adherence to a local ordinance
man-dating the cleanliness and tidiness of outdoor premises. (Bo
Burström, MD, PhD; Gloria Macassa, MD; Lisa Öberg, PhD; Eva Bernhardt, PhD; and
Lars Smedman, MD, PhD, “The Impact of Improved Water and Sanitation on
Inequalities in Child Mortality in Stockholm, 1878 to 1925,” Public Health Now
and Then, vol. 95, no. 2, February 2005, p. 210.)
Accordingly, the present
generation is beginning to learn and will realize more thoroughly as time wears
on that the fatalistic idea with regard to contagious and infectious disease is
absolutely erroneous and that many so-called unavoidable diseases are positively
preventable. It is not true each individual must run the gamut of measles,
scarlet fever, whooping cough, diphtheria, tuberculosis and the like if proper
pre-cautionary measures be taken at the outset. Sunshine, fresh air,
wholesome nutrition, exercise, rest and the hygienic mode of living are far more
effectual than all the subsequent medication in existence. (Charles
E. Page, MD, “Diphtheria: Is the Prevailing Antitoxin Treatment Only Another
Medical Delusion?” Medical Brief, A Monthly Journal of
Scientific Medicine and Surgery, vol. XXXV, 1907, pp. 482–483.)
The public-health movement
is said to be responsible for the reduction in mortality from diarrhea and
enteritis [inflammation of the small intestines], which in 1930 had a rate of
20.4 per 100,000 and in 1940 had dropped to a rate of 4.6. Advances in
sanitary science, including the Pasteurization of milk, the better refrigeration
of foods, and the purification of water supplies, as well as the general rise in
the standard of living, are the main reasons for this improvement. (Handbook
of Labor Statistics, 1941 Edition, US Department of Labor, pp. 396–397.)
The United State Public
Health Service licensed a new, refined, live-measles vaccine. Although several
live vaccines have been licensed since 1963—all of them one-shot treatments that
give life immunity without serious side-effects—the new one is considered by
epidemiologists as “the best so far in minimizing the side-effects.” (Thaler
to Hold State Senate Hearing to Find Fastest Way to Expedite Plan,” New York
Times, February 24, 1965.)
Effective use of these
vaccines during the coming winter and spring should insure the eradication of
measles from the United States in 1967. (David
J. Sencer, MD; H. Bruce Dull, MD; and Alexander D. Langmuir, MD, “Epidemiologic
Basis for Eradication of Measles in 1967,” Public Health Reports, vol. 82, no.
3, March 1967, p. 256.)
Some of the first vaccines
mass produced in 1963 contained a killed virus. In 1989 Dr. Feigin of Texas
Children’s Hospital stated that he believed the 1963 vaccine was “not widely
effective” and that the 1967 vaccine was unstable and lost its “effectiveness”
if not properly refrigerated. It was not until 1980 that a stable live
measles vaccine became available. (Lisa
Belkin, “Measles, Not Yet a Thing of the Past, Reveals the Limits of an Old
Vaccine,” New York Times, February 25, 1989.)
This outbreak demonstrates
that transmission of measles can occur within a school population with a
documented immunization level of 100%.
This level was validated during the outbreak investigation. Previous
investigations of measles outbreaks among highly immunized populations have
revealed risk factors such as improper storage or handling of vaccine, vaccine
administered to children under 1 year of age, use of globulin with vaccine, and
use of killed virus vaccine. However, these risk factors did not adequately
explain the occurrence of this outbreak. (Measles
Outbreak Among Vaccinated High School Students—Illinois,” MMWR, Centers for
Disease Control and Prevention, June 22, 1984, p. 349.)
...multiple measles
outbreaks have occurred in school populations in which 71% to 99.8% of the
student body had been vaccinated appropriately... Startling at the time was
the finding that measles outbreaks developed in these school populations even
though more than 98% of the students had previously been vaccinated... In the
particular case of measles, “herd immunity” is not completely effective in
preventing an outbreak of measles despite extraordinarily high immunization
rates. (Gregory A. Poland, MD, and
Robert M. Jacobson, MD, “Failure to Reach the Goal of Measles Elimination:
Apparent Paradox of Measles Infections in Immunized Persons,” Archives of
Internal Medicine, August 22, 1994, pp. 1816–1818.)
Measles outbreaks are
occurring where they are least expected... Since 2005 these outbreaks have
occurred in the U.S.—with surprising numbers of cases occurring in persons
who previously received one or even two documented doses of measles-containing
vaccine. In fact, as of September 2011, the U.S. has had 15 measles
outbreaks with 211 confirmed cases—the highest number of cases since 1996. (G.
A. Poland and R. M. Jacobson, “The Re-emergence of Measles in Developed
Countries: Time to Develop the Next-Generation Measles Vaccines?” Vaccine, vol.
30, no. 2, January 5, 2012, pp. 103–104.)
Combined analyses showed
that massive doses of vitamin A given to patients hospitalized with measles were
associated with an approximately 60% reduction in the risk of death overall,
and with an approximate 90% reduction among infants... (Wafaie
W. Fawzi, MD; Thomas C. Chalmers, MD; M. Guillermo Herrera, MD; and Frederick
Mosteller, PhD, “Vitamin A Supplementation and Child Mortality: A
Meta-Analysis,” Journal of the American Medical Association, February 17, 1993,
p. 901.)
Vitamin A administration
also reduces opportunistic infections such as pneumonia and diarrhea associated
with meales virus-induced immune suppression. Vitamin A supplementation has been
shown to reduce risk of complications due to pneumonia after an acute measles
episode. A study in South Africa showed that the mortality could be reduced
by 80% in acute measles with complications, following high-dose vitamin A
supplementation. (Prakash Shetty,
Nutrition Immunity & Infection, 2010, p. 82.)
During an epidemic [of
measles] vitamin C was used prophylactically and all those who received as much
as 1000 mg. every six hours, by vein or muscle, were protected from the virus.
Given by mouth, 1000 mg. in fruit juice every two hours was not protective
unless it was given around the clock. It was further found that 1000 mg. by
mouth, four to six times each day, would modify the attack; with the appearance
of Koplik’s spots and fever, if the administration was increased to 12 doses
each 24 hours, all signs and symptoms would disappear in 48 hours. (Fred
R. Klenner, MD, “The Treatment of Poliomyelitis and Other Virus Diseases with
Vitamin C,” Southern Medicine & Surgery, July 1949.)
Because measles-specific
antibody titer after vaccination is lower than after natural infection,
there is concern that vaccinated persons may gradually lose protection from
measles. Secondary vaccine failure (loss of immunity over time), in contrast
to primary vaccine failure (no protection immediately after vaccination), is a
concern because of the potential insidious challenge to measles elimination. For
instance, if vaccine-induced immunity wane to nonprotective levels in a high
proportion of vaccinated adults, the level of population protection might
decline to allow recurrence of endemic disease. By means of statistical
modeling, Mossong et al. predicted waning of vaccine-induced immunity 25
years after immunization. (Mark S.
Dine, Sonja S. Hutchins, Ann Thomas, Irene Williams, and William J. Bellini, et
al., “Persistence of Vaccine-Induced Antibody to Measles 26–33 Years After
Vaccination,” Journal of Infectious Diseases, 2004, p. S123.)
We can foresee that
vaccination will have two conflicting effects... it will reduce the number
of newborn susceptibles and hence should have some of the usual associated
public-health benefits reducing the number of cases in young children. However,
this reduction in cases will lead to a reduction in boosting and
therefore a greater susceptibility to infection in older age classes...
When immunity wanes, vaccination has a far more limited impact on the average
number of cases. While this observation has clear public-health implications,
the dynamic consequences of the interaction between vaccination, waning immunity
and boosting are far more striking. For high levels of vaccination (greater than
80%) and moderate levels of waning immunity (greater than 30 years), large-scale
epidemic cycles can be induced. (J.
M. Heffernan and M. J. Keeling, “Implications of Vaccination and Waning
Immunity,” Proceedings of the Royal Society B, vol. 276, 2009.)
Waning immunity
may become an increasing problem as vaccine coverage increases: because more
mothers will have been vaccinated and since they have not been exposed or had
natural measles, they will transmit lower levels of maternal antibody. Thus
their babies become susceptible to measles by 3 to 5 months of age. (Oxford
Textbook of Medicine, vol. 1, 2005, p. 357.)
The starting concentrations
of maternal antibodies in infants in this study depended highly on the
concentration of antibodies in the mother and on her vaccination status. Infants
of vaccinated women started with significantly fewer antibodies than did infants
of naturally immune women. Infants of women vaccinated against measles
receive fewer maternal anti-bodies and thus have shorter protection than infants
of women with naturally acquired immunity.
(E. Leuridan, N. Hens, V. Hutse,
M. Ieven, M. Aerts, et al., “Early Waning of Maternal Measles Antibodies in Era
of Measles Elimination: Longitudinal Study,” British Medical Journal, 2010.)
One of
the most disconcerting discoveries in clinical medicine was the finding
that children with congenital agamma-globulinaemia, who could make no antibody
and had only insignificant traces
of immunoglobulin in circulation, contracted measles in normal fashion,
showed the usual sequence of symptoms and signs, and were subsequently immune.
No measles antibody was detectable in their serum [the water part of blood
minus clotting factors and cells].
(“Measles as an Index of Immunological Function,” The Lancet, September 14,
1968, p. 611.)
...children with antibody deficiency syndromes have quite unremarkable attacks
of measles with the characteristic rash and normal recovery. Furthermore, they
are not unduly prone to reinfection. It therefore seems that serum antibody,
at any rate in any quantity, is not required for the production of the measles
rash; nor for the normal recovery from the disease; nor to prevent reinfection.
(P. J. Lachmann, “Immunopathology of
Measles,” Proceedings Royal Society of Medicine, vol. 67, November 1974, p.
1120.)