Personal choice versus public safety

doctor giving child a shotA recent outbreak of measles in Vancouver, as well as newly released study on a 2008 outbreak in the San Diego area, are raising questions about intentionally unvaccinated children and the potential health threat and costs they could pose to the public.

Despite a lack of scientific evidence linking the measles, mumps and rubella vaccination to cases of autism, some parents fear vaccinations can lead to the disorder and opt not to have their children vaccinated.

“In general people underestimate the risk of the diseases that vaccines protect against, and overestimate the risks/side effects of the vaccines,” says Ronald Samuels, MD, MPH, assistant in medicine in  General Pediatrics at Children’s Hospital Boston.“There are many people who believe that vaccines cause problems that are just not so.”

And while the decision whether or not to vaccinate is up to the parent, recent studies have shown that non-vaccination can affect the public at large.

According to a study done by members of the San Diego County health agency and the Centers for Disease Control and Prevention, the case that sparked the 2008 San Diego outbreak was traced to an intentionally unvaccinated 7-year-old, who unknowingly brought the virus to the U.S after contracting it on a family trip to Switzerland.

For the next month and a half, it was estimated that the child potentially exposed an additional 839 people, resulting in 11 confirmed new measles cases—all found in unvaccinated children. In addition, 48 children who were too young to have been vaccinated had to be quarantined for three weeks as a precautionary measure. The study estimated that containing the virus cost the public-sector $10,376 per case.

In a similar story, Vancouver is currently containing an outbreak of the measles, believed to be brought over by foreign travelers who visited the city for the Winter Olympics.

Diagnoses of the two Canadians and one Americans initially infected with measles came out around the time of the games’ closing ceremonies, when thousands of people gathered in large crowds throughout the city. So far, measles has spread to 16 people in Vancouver, with eight of the cases coming from one intentionally unvaccinated household.

Because vaccinations rates in North America are very high, measles outbreaks like the ones in San Diego and Vancouver are rare, but due to the extremely contagious nature of the virus, even a single case has the potential to spread rampantly. Containment is also expensive. Direct medical charges, quarantining costs, and the pay of state and county personnel who become involved in the containment all cost both the public and private sector.

However, Samuels points out that incidents like San Diego and Vancouver are usually exceptions to the rule. “Internationally unvaccinated children are generally very small in number, and when they come to this country usually get vaccinated if they’re staying,” he says.