February 15, 2024
Fat Tuesday
I didn’t get this finished up right away because some important things had to be done. Like going to the Old Time jam at the Couth Buzzard on Tuesday night. Playing tunes is always in order. And then last night we saw the wonderful band Tangoheart for their Valentine’s Day concert of Astor Piazzolla’s compositions at the Royal Room. I am in awe of their music. Stunning, life affirming. Jamie and I last saw them on Valentine’s Day 4 years ago, just as reports of a novel virus were coming across the Pacific. So much has happened since then, and yet, it feels as if it wasn’t that long ago. We all need hanging out time like this!
On Monday, I wrote about concerning outbreaks of measles occurring across the globe, including the US. A combination of missed vaccines during the pandemic and increased vaccine hesitancy, spurred on by disinformation campaigns. Measles is the most infectious virus known, with a transmission rate, or R0, of 13-16. That means each case can infect 13-16 unvaccinated or non-immune people who can then spread it further. Compare that to COVID whose R0 is about 2.5. That’s why we hear about measles exposures in airports, shopping centers, and waiting rooms.
The MMR vaccine is used to cover measles, mumps, and rubella. It is 97% effective, so it’s possible that 3% not responding may have a breakthrough case. Measles is a prime example of herd immunity, which means if a certain threshold of people are immune to a virus, non-immune people are protected because the virus won’t spread. There’s no one to infect.
The herd immunity threshold for measles is 95%. That means if at least 95% of people have been immunized at least 2 times for measles or they had a past infection, then an outbreak can’t happen. In the US, outbreaks are generally in communities with low vaccination rates. Vaccination rates are dropping and that is a big concern. Thirty six states are below the 95% vaccine threshold for kindergarteners so news of more cases is worrisome for more spread.
The CDC and WHO assume anyone born before 1957 had measles as kids, so no vaccine required. But everyone born later needs them. If an immunized person catches measles, their cases are milder, without the risks of hospitalizations, deafness, and deaths that the un-immunized might have.
Do you need to worry if you were fully immunized? We know that immunity can wane, or weaken over time. Katelyn Jetelina, Your Local Epidemiologist, once again explains this very well. After 17 years, 91% still had strong antibodies when tested, as opposed to the mumps part of the MMR when protective antibodies dropped 50% after 19 years. Rubella wanes too. At this point, experts do not recommend an MMR booster for measles. They might for rubella or mumps in the right circumstances, such as an adolescent off to college or a woman that isn’t immune to rubella getting the MMR before she is pregnant.
A big concern is that infants less than 12 months old are not immunized for measles. That leaves them vulnerable in an outbreak. The reason is that infants have maternal antibodies that protect them and would interfere with vaccine response for their first 6 months at least, maybe longer, but possibly not enough to protect them. Plus the immune system is maturing and can respond to the vaccine better when it’s older. In the past measles generally occurred in children older than one year. In outbreaks now, the infants are vulnerable.
The big question most people have is, “Why are the measles vaccine and others so much more effective than the ones for COVID and Influenza?” It’s not because most of the COVID vaccines were mRNA based. A big reason is because of mutations that occur frequently in SARS-CoV-2 (the virus that causes COVID-19) and Influenza viruses that replicate quickly. The mutations in SARS-CoV-2 caused the variants to be transmitted more easily, allowing infections to spread. The good news is that the vaccines gave partial immunity that protected people from becoming seriously ill. The bonus of mRNA vaccines for SARS-CoV-2 is that they are easy to adjust to the new mutations that pop up.
Other viruses, like measles, are more stable and don’t make mutations as often. Even though measles is faster at spreading, it’s slower at replicating.
Another reason is where the virus attaches and reproduces. The coronavirus attaches to cells in the nasal passages. The immune system takes time recognizing an infection in the nose before it can start to fight it. Testing is being done on nasal spray vaccines that can induce local immunity and fight SARS-CoV-2 before it gets attached, using a different part of the immune system.
Measles goes deeper into the body where there are more antibodies available to fight it. Other reasons immunity doesn’t last as long is knowing how many doses of vaccines are needed and how long between doses. These take time to discern.
Some viruses, such as HIV and Hepatitis C, still don’t have vaccines, despite years of research. So we are lucky to have the ones that work for COVID.
All in all, vaccine side effects are less risky than the disease its fighting. They work well enough so disease like measles are rare and parents have never seen cases. They hear that the vaccine is worse than the disease, becoming skeptical. Tough to counteract this disinformation when “influencers” have more pull than trained scientists and physicians.
If you know doubters out there, this CDC page has facts about vaccines that might help. The CDC has another page that answers many of your questions about measles. These facts can help “inoculate” people against disinformation.
All in all, the complexity can be daunting, but I’ve lived long enough that I’ve seen the before and after of vaccines.
More time for chilling, less time for worry.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available. Thanks for reading.
Share this post if you know of others who may be interested. All links are listed at the bottom of this post. The New York Times articles have links that are gift links, allowing you to read the article for free.
A gentle reminder that I am now writing more regularly because I’ve committed to doing so by turning on Paid Subscriptions. Read about it here in this post: A Special Message. Most of my writing will remain free. Pay only if you wish to and are able to. The cost is $5/month, $50/year, $100 Founding Member, bonus is ability to post and other content. Think of it as tipping for a busker. Thanks to all who have paid already!
https://buonobuzzard.com
https://www.tangoheart.com/about
https://www.strangertickets.com/events/146958743/tangoheart-a-piazzolla-valentine
https://www.nytimes.com/2023/02/16/style/sheila-liming-hanging-out-interview.html?unlocked_article_code=1.VE0.o1Ya.3Pxjzd6gJ0ot&smid=url-share
https://www.usatoday.com/story/news/health/2024/02/07/measles-cases-us-states-map/72507771007/
https://www.cdc.gov/measles/about/faqs.html
https://www.cdc.gov/mmwr/volumes/67/wr/mm6742a4.htm?s_cid=mm6742a4_w
https://www.cdc.gov/vaccines/hcp/conversations/understanding-vacc-work.html
https://academic.oup.com/aje/article-abstract/192/8/1379/7080124?login=false
https://www.cedars-sinai.org/blog/why-vaccine-boosters.html
https://www.npr.org/sections/goatsandsoda/2024/01/23/1226155791/why-diphtheria-is-making-a-comeback
https://www.nbcnews.com/health/health-news/measles-outbreaks-anti-vaccine-misinformation-rcna136994
https://www.cdc.gov/measles/about/faqs.html
https://www.cdc.gov/vaccines/hcp/conversations/understanding-vacc-work.html
https://www.seattletimes.com/business/google-finds-inoculating-people-against-misinformation-helps-blunt-its-power/
https://www.nytimes.com/2019/01/19/opinion/vaccines-public-health.html
https://www.nytimes.com/2019/10/31/health/measles-vaccine-immune-system.html?unlocked_article_code=1.VE0.Y2ln.FmbnT5dpWA-9&smid=url-share
https://www.cdc.gov/mmwr/volumes/72/wr/mm7245a2.htm?s_cid=mm7245a2_w
https://www.cdc.gov/measles/cases-outbreaks.html
https://www.cedars-sinai.org/blog/why-vaccine-boosters.html
https://www.seattletimes.com/business/google-finds-inoculating-people-against-misinformation-helps-blunt-its-power/