Forgotten illnesses making a comeback

Will we see outbreaks of measles following the London 2012 Olympics? Could your child or grandchild come down with whooping cough? Should we watch out for mumps this fall?

These questions may have you scratching your head — didn’t we relegate these preventable diseases to the history books with the invention of vaccines? If you’ve been following the news lately, you know these illnesses are alive and well and keeping health experts up at night. While we’re mired in news reports about cancer, heart disease and Alzheimer’s, it’s easy to forget that these illnesses can be serious and even deadly.

Here’s a look at what’s going on.

Forgotten diseases back in the news

Measles: Why the concern about the Olympics? In the past few months, the U.K. has seen several outbreaks of measles. Now London is packed with travellers from all parts of the world and the highly contagious virus may become an unwanted souvenir that spreads among communities back home.

Measles outbreaks in Europe aren’t new. In 2011, France reported the highest incidence of measles with more than half of Europe’s cases, and the country has seen over 14,000 cases since last October. Add in Germany, Romania, Spain and Italy and these five countries alone claimed 90 per cent of all of Europe’s cases. This year, San Marino, Russia and the Ukraine are seeing an uptick in cases.

Measles isn’t a stranger in developing countries throughout Asia and Africa, but it’s also showing up closer to home. Last fall, measles made the rounds in parts of Canada — including Montreal and central Quebec.

Whooping cough: More formally known as pertussis, this bacterial disease known for uncontrollable fits of coughing is on the rise in North America. Washington has been struggling with an epidemic — over 3,400 cases since the beginning of 2012, according to the Washington State Department of Health. (That’s nearly 12 times as many cases compared to the same period in 2011.) Oregon is battling a rise of cases as well with 572 cases so far this year compared to just 190 last year, says its Department of Health. Across the U.S., there have been nearly 20,000 cases to date.

In the U.K., experts also report a surge in cases — 2,466 confirmed cases between January and June of 2012 according to the Health Protection Agency. To put that number in perspective, that’s six times as many cases as a previous outbreak in 2008.

What about Canada? So far, Manitoba and New Brunswick have issued health advisories encouraging residents to get their vaccinations. Outbreaks have affected communities in British Columbia’s Fraser Valley, southern Alberta and southwestern Ontario too. As of June, Canada had seen 2,000 cases in 2012, including the death of an infant.

Mumps: In the past decade, experts say we’ve seen a few outbreaks — including one in spring 2011 in lower British Columbia.

And more could be on the way. Why? Mumps prevention is part of the MMR vaccine that more people have been skipping due to vaccine controversies. Officials in the UK are warning that mumps could make a comeback in England this fall, according to a report in the Guardian.  The disease usually shows up in winter, so experts will be keeping a close eye as students head back to school and off to university.

What’s behind the comeback?

There’s no single culprit behind the re-emergence of these diseases, but experts note several factors could be to blame:

Fewer people are getting vaccinated. Vaccines have gotten a bad reputation in recent years due to claims they cause autism or they’re a money grab for greedy “big pharma” companies. Some parents opt out for religious reasons, and some people simply underestimate the dangers of these diseases.

For a while, the abstainers were safe thanks to “herd immunity” — that is, enough people were protected that diseases didn’t take hold in communities. That’s not the case anymore.

Whether you agree or disagree with the anti-vaccine movement, the fact is illnesses typically spread among people who haven’t been immunized. (For example, places like France and Washington state that have lower rates of vaccination are more prone to outbreaks.) Anyone who chooses not to be protected can put others at risk — like people with weakened immune systems and children too young to be vaccinated.

Vaccines may lack staying power. Wouldn’t it be nice to “get it and forget it”? Unfortunately, our immunity can wane in the first few years after getting a vaccine — and before we’re scheduled for a booster shot. In some whooping cough outbreaks, many of the people infected were pre-teens who had the vaccine.

Vaccines aren’t as effective as they used to be. Vaccines may not be effective 100 per cent of the time, but experts worry today’s offerings aren’t as potent as in the past. In the case of whooping cough, experts note that over the decades companies have moved to vaccines that are considered safer and that cause fewer side effects. Unfortunately, that safety may come at the price of effectiveness.

Disease cycles. These diseases never completely vanish because vaccines aren’t 100 per cent effective. In some areas, it’s normal to see a handful of cases each year but it’s worrisome to see dozens or hundreds of cases. Viruses and bacteria continue to change and to find new people to infect — namely younger generations whose immune systems haven’t been exposed to the germs. Experts expect to see a temporary rise in cases every four or five years — but not to the extent they’re seeing now.

Travel helps spread illnesses. What does a measles outbreak in the U.K. or a whooping cough outbreak in another province have to do with your community? It’s now even easier for germs to get around thanks to an increase in travel over the past several decades. Diseases like measles may be fairly rare in North America, but the same can’t be said for the rest of the world.

According to the Centers for Disease Control and Prevention, about 40 per cent of people who develop measles picked it up in a foreign country — they then spread it to others in their community and an outbreak occurs. It can take several days for symptoms to appear, so many people don’t realize they’re contagious.

What should people do? As you would expect, experts recommend that people keep up with their booster shots — especially if they plan to travel abroad — and that children should receive MMR and DTP vaccinations according to guidelines.

Not everyone is going to agree with this advice, and it can be difficult to wade through the information (and misinformation) available on the Internet. As always, experts say you should talk to your doctor if you have any concerns — and weigh the benefits versus risks of any treatment.

Sources: CBC News, Health Canada, Newsweek, NPR, Oregon State Department of Health, Public Health Agency of Canada, The Toronto Star, Washington State Department of Health

Photo © mark wragg

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