Vaccine-Preventable Diseases: Current State of Affairs

If you’ve been following the news the last few months, you’ve probably noticed once again we are experiencing a dramatic shift in public health priorities. Last year we wrote several articles on the stresses and strains facing the Centers for Disease Control (CDC) in Atlanta. As you may recall, the year did not start well for the CDC when it was reported that breaches in protocol at several of its laboratories could have left laboratory research personnel at risk. This was poor timing, considering that both CDC and the World Health Organization (WHO) were scrambling to contain a potentially devastating disease outbreak on the other side of the globe.

 

Roger Morey of the CDC Meningitis and Special Pathogens Branch (MSPB) in the National Center for Infectious Diseases (NCID) performing DNA sequencing on pathogens like Bordetella pertussis which causes Whooping Cough. Photo courtesy CDC/ Maryam I. Daneshvar, Ph.D.
Roger Morey of the CDC Meningitis and Special Pathogens Branch (MSPB) in the National Center for Infectious Diseases (NCID) performing DNA sequencing on pathogens like Bordetella pertussis which causes Whooping Cough. Photo courtesy CDC/ Maryam I. Daneshvar, Ph.D.

That was Ebola, Right?

No! It actually wasn’t the Ebola outbreak in Western Africa! At the time, the major public concern was the mysterious outbreak of the Middle East Respiratory Syndrome known as MERS. Public health officials were scrambling to understand the root cause of this new syndrome and to prevent its spread around the world, which at the time seemed very likely due to the large-scale, annual religious pilgrimages by Muslims to Saudi Arabia.

Unfortunately for government leaders, laboratory researchers and public health officials, disease outbreaks in nature don’t follow our rules or expectations. For some reason, deadly pathogens seem happily unaware that it takes months if not years for governments and the pharmaceutical industry to react. And food-borne illnesses don’t seem to recognize that our annual health budgets are planned years in advance!

 

Ebola Outbreak: Lessons Learned Here at Home?

The reality is when there is an unexpected disease outbreak, everyone has to scramble and move as quickly as possible to address the issue. The recent West African Ebola outbreak has taught us all some important public health lessons. The good news is that, despite the lack of an approved vaccine, traditional public health measures of quarantine control seem to have finally taken root in Guinea, Sierra Leone, and Liberia. Now that the hysteria about Ebola has lessened here at home, it’s a good time to think about the important role that our public health system plays in protecting ourselves, our families and friends. There’s certainly room for improvement.

In the next epidemic, having better access to health care records could help public health officials respond more effectively to a massive disease outbreak. Here in Texas, the regional non-profit health information organizations have come together to promote a statewide system in an initiative they call LinkTexas.Healthcare. Initiatives like these could play a critical role in identifying and containing a future epidemic, not if but when it comes.

 

But What if People Have the Right Information but Don’t Act on It?

Now that the Ebola virus in West Africa is fading from the 24×7 cable news channels, we are confronted with the realization that we are facing multiple public health crises here at home.

 

Thin-section transmission electron micrograph (TEM) reveals a single virus particle, or virion, of measles virus. Measles is one of the most highly contagious diseases. Photo courtesy of Cynthia Goldsmith, CDC
Thin-section transmission electron micrograph (TEM) reveals a single virus particle, or virion, of measles virus. Measles is one of the most highly contagious diseases. Photo courtesy of Cynthia Goldsmith, CDC

 

Here in the USA, we’re now confronting an outbreak of one of the most contagious diseases known, measles. This is a disease that was virtually wiped out domestically in the year 2000. What went wrong? We’re also seeing unprecedented return of pertussis, commonly known as whooping cough. Again, we have to ask what went wrong?

 

Senate Hearing on Vaccine-Preventable Diseases

In an effort to find out what has gone wrong, the United States Senate conducted a hearing last week (February 10th) to gather testimony from Rear Admiral Anne Schuchat, MD, Director, National Center for Immunization and Respiratory Diseases at the Centers for Disease Control (CDC).

Dr. Schuchat has a pretty remarkable background in public health. Concurrent with the 9/11 attacks on New York City and the Pentagon, you may recall the anthrax scare: Dr. Schuchat led the CDC’s Anthrax Emergency Response Team, which was called in to identify and contain those deadly pathogens. Dr. Schuchat has also conducted meningitis vaccine studies in West Africa, provided emergency response to the SARS epidemic in China, worked on preventing infectious streptococcal disease in children, and helped lead the response to the H1N1 scare in 2009. When you watch the C-SPAN video of her testimony to Congress, you might be left with the impression that she’s come directly to us from central casting at a Hollywood film studio. If so, you might be closer than you realize, as she was one of the inspirations for the fictional character of Erin Mears in the 2011 film Contagion. British actress Kate Winslet met with Dr. Schuchat when preparing for her role in the film.  

British actress Kate Winslet, who portrayed the character Erin Mears, consulted with Rear Admiral Anne Schuchat, MD when preparing for her film role in the 2011 film Contagion. Poster image courtesy Warner Bros.
British actress Kate Winslet, who portrayed the character Erin Mears, consulted with Rear Admiral Anne Schuchat, MD when preparing for her film role in the 2011 film Contagion. Poster image courtesy Warner Bros.

 

Dr Schuchat’s testimony was plainspoken and honest, based on her years of public health service. In her view, we may be a victim of our own success. Thankfully, diseases like measles, mumps and rubella have become — for most Americans — a distant memory. The current generation of parents really hasn’t had direct experience with how devastating these diseases can be, and they have come to believe that vaccines are not that critical for the health of their own children. To her point, Sen. Lamar Alexander reminded us that Mitch McConnell, the new leader of the Senate, contracted polio when he was young and has had lifelong complications from this disease.

Schuchat’s testimony also touched on an unfortunate irony: that while we were focusing our fears on the threat of Ebola in West Africa, we dropped the ball here at home in maintaining our ‘herd immunity’ against vaccine-preventable diseases.

 

Rear Admiral Anne Schuchat, MD, Director, National Center for Immunization and Respiratory Diseases at CDC, testified to a Senate Hearing on Vaccine-Preventable Disease held last week in Washington, DC.
Rear Admiral Anne Schuchat, MD, Director, National Center for Immunization and Respiratory Diseases at CDC, testified to a Senate Hearing on Vaccine-Preventable Disease held last week in Washington, DC.

 

She noted that in some micro-communities, vaccine rates for common childhood immunizations, such as the so-called MMR vaccination for measles, mumps and rubella (German Measles) had fallen to as low as 50%! As a former leader in the federally-funded Vaccines for Children (VFC) Program, Schuchat said that 90% vaccination rates are necessary to help protect the most vulnerable among us, including newborns under the age of one who cannot be vaccinated.

She also addressed head on the issue of the now discredited Lancet study, which had linked onset of autism with vaccines. She reminded the congressional committee that this report was found to contain falsified fabricated data and that the author had lost his medical license. We’ll continue our investigation of public health and laboratory vaccine development in an upcoming article. Stay tuned.

 

X-ray angiocardiogram of right pulmonary artery showing stenosis contstriction caused by the patient’s mother contracting Rubella (German Measles) during pregnancy. Photo courtesy CDC / Dr. Andre J. Lebrun
X-ray angiocardiogram of right pulmonary artery showing stenosis constriction caused by the patient’s mother contracting Rubella (German Measles) during pregnancy. Photo courtesy CDC / Dr. Andre J. Lebrun

 

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