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Yesterday, Hank Green and the YouTube channel SciShow posted a particularly good video on the anti-vaccination movement. Unlike many commentators from within the science community, instead of vilifying parents who don’t get their kids vaccinated – or are hesitant about doing so – Green takes a science-grounded look at why people reject vaccines.

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Yesterday, I posted a piece examining the oft-quoted mortality rate for measles of one to two deaths per thousand cases of infection.  Today, I want to look at what can be learned from more recent and more comprehensive dataset – this one from the 2008-2011 measles outbreak in France. In the early 2000’s, measles was a relatively rare occurrence in France.  From 2008 to 2011 though, there was a dramatic increase in cases – peaking at over 3,000 new cases per month being recorded in 2011.  Because the outbreak occurred in a developed country where the disease was no longer considered a pressing pubic health issue, it provides a unique opportunity to estimate mortality rates following infection by the virus in economies with robust healthcare systems. In 2013, Denise Antona and co-authors published a comprehensive assessment of the outbreak in the Centers for Disease Control and Prevention journal Emerging Infectious Diseases.   Over the four year study period, there were 22,178 documented cases of measles.  11.6% of cases (2,582) involved complications , including pneumonia (1,375 cases, 6.2%), acute otitis media (321 cases, 1.4%), and hepatitis or pancreatitis (248 cases, 1.1%). According to the paper’s authors, diarrhea was reported in 100 cases (0.4%). Overall, there were ten deaths reported (0.05%). The data are particularly useful for examining morbidity and mortality rates associated with measles in a developed country like France, as with the relative novelty of the disease, the number of reported cases is likely to have been substantially higher than in earlier decades when the disease was commonplace. In table 1 below (based on Antona et al.’s paper), the number of measles-related complications per 10,000 cases of infection is given for different health impacts and age ranges, based on individuals who were hospitalized. Focusing specifically on mortality, the overall rate was 4.5 deaths per 10,000 documented cases of

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If you catch measles, what are your chances of dying? When I was a kid, measles was one of those things you were expected to catch.  I had it when I was five, and must confess, I don’t remember much about the experience.  I do remember being confined to bed.  And I also remember being told that measles could cause blindness – as a budding reader, this scared me.  But I don’t recall anyone hinting at anything worse.  If my parents were worried, they didn’t show it. And I’d certainly never heard of kids who had died – even in playground rumors. So as the current outbreak of measles in the US continues to spread, I’ve been intrigued by statements that the disease has a mortality rate of somewhere between one and three young children per thousand infected. Of course I know as a public health academic that measles is highly infectious and can cause severe harm – even death.  But there was a dissonance between what I was reading and what I felt was correct. Surely if one out of every few hundred kids died as a result of measles as I was growing up, I’d have got wind of it? The mortality rate of around 1 in 1000 though comes with a sound provenance.  It’s there in black and white on the Centers for Disease Control and Prevention (CDC) web pages: “For every 1,000 children who get measles, one or two will die from it” A 2004 review in the Journal of Infectious Diseases provides further insight.  Using CDC data on reported measles cases in the US between 1989 and 2000,Orenstein, Perry and Halsey indicated that approximately three children under the age of five died for every thousand that caught measles, and that the overall mortality rate for all ages was also around 3 per thousand people infected – the table below gives the

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Measles is one of the leading causes of death amongst children worldwide.  In 2012, an estimated 122,000 people died of the disease according to the World Health Organization – equivalent to 14 deaths every hour.  Yet talk to parents about this highly infectious disease, and the response is often a resounding “meh”.  Why is this?   University of Michigan Professor Brian Zikmund-Fisher explores this in the latest video from Risk Bites – at under 3 minutes long, it’s a fantastic introduction to why seemingly rational people sometimes behave the way they do toward vaccines. According to Zikmund-Fisher, how we think about infectious diseases and risk is governed in part by the way our memories and feelings inform our perceptions – this is referred to by psychologists as the “availability heuristic”.  It turns out that when we try and figure out how rare or common a disease is, we try to think of people we have heard of who have had it.  If we know of people, we’re pre-programmed to feel more at risk than if we don’t.  And surprisingly, the statistics – the actual numbers of people who get sick – don’t seem to matter. You can watch Brian’s video and others on the science behind human health risks at youtube.com/riskbites.  Brian can also be seen talking about risk, feelings and vaccines in the new NOVA documentary Vaccines – Calling The Shots, airing Wednesday September 10 at 9:30/8:30C. Image: Sixteenth century Aztec drawing of a measles victim.  Source: (2009) Viruses, Plagues, and History: Past, Present and Future, Oxford University Press, USA, p. 144 ISBN: 0-19-532731-4.  

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NOVA has a one hour special on child vaccination coming out on September 10th, which is sure to stimulate some heated conversation around the topic.  It also features heavily University of Michigan School of Public Health decision-analysis expert Brian Zikmund-Fisher – who also leads the Risk Science Center Risk Communication initiative.

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2020 Science is published by Andrew Maynard - Director of the Risk Innovation Lab at Arizona State University. More ... 

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