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zoom RSS 米国での麻疹(はしか)流行 2001年以来の規模/米国医療事情

<<   作成日時 : 2008/05/02 22:20   >>

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画像 米国で少なくとも7つの州のはしかの発症が最近では最も多くなっていると警告がでた。ほとんどは予防接種を受けていない例で、1月〜4月に64例で昨年1年より多く、2001年以来の数値であり、今後も増加すると予測している。まだ流行は終息していない。14人(22%)が、主に肺炎のため入院した。世界中では年に2000万人が罹患するので、主に旅行者がウイルスを他国に持ち込み、予防接種していない人(1才以下の乳児や、家族が接種を拒否している場合)に感染する。医師看護師を含め、現役世代は麻疹を知らない。17例はクリニックで感染している、うち1例の1才乳児はワクチン接種に受診して感染した。
 13例は1才前、7例は12-15ヶ月、16例は家族のワクチン接種拒否。標準的なワクチン2回接種を受けて感染したのは1例のみ。
 8人の子供が、5ヶ国2000人が出席した宗教会議ではしかに感染した。予防接種は受けていない。
 イスラエル、スイス、オーストリア、アイルランド、および英国は、予防接種を避ける人々が増加して最近大きな流行ご起きている。
 1963年にワクチンが導入される前は、年に300-400万人が感染し、子供400-500人が死亡、48,000人が入院した。世界では今でも年に242,000人の子どもが死亡している。
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Measles in U.S. at Highest Level Since 2001
http://www.nytimes.com/2008/05/02/health/02measles.html

By DENISE GRADY
Published: May 2, 2008

Measles outbreaks in at least seven states are expected to produce the highest number of cases in recent years, federal health officials said Thursday, warning that measles is highly contagious and can cause severe illness and even death.

Most of the cases occurred in people who had not been vaccinated.

There were 64 cases from January through April 25, more than in all of 2006, and the highest number during this four-month period since 2001. Officials said they expected the total to keep rising.

“We haven’t seen the end of this,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

Fourteen patients, or 22 percent, have been hospitalized, mostly for pneumonia.

The largest outbreak ― 22 cases ― is going on in New York City, mainly in Borough Park, Brooklyn, where it was most likely introduced by travelers from other countries, including Israel and Belgium.

“There may be more cases,” said Dr. Jane R. Zucker, assistant commissioner for the bureau of of immunization in the city’s Health Department. She said the outbreak was still being investigated.

The other outbreaks are also occurring because travelers bring the measles virus in from other countries ― worldwide there are 20 million cases a year ― and spread it to unvaccinated people. The unvaccinated include babies under a year old, who are too young to receive the vaccine, and other children and young adults from families who refuse vaccination for personal or religious reasons.

The disease can then keep spreading. Dr. Schuchat said doctors were finding clusters with three, four and five generations of transmission.

She said many of the current generation of parents, doctors and nurses were not familiar with measles and not on the lookout for it.

In 17 cases, patients were infected in clinics and doctors’ offices, including a year-old baby who contracted the disease in a pediatrician’s office during a routine visit ― for a measles shot.

Health officials are warning doctors and nurses to take special precautions to avoid spreading the disease in clinics. Children with fevers and rashes should not sit in waiting rooms, and other children should not be brought into an examining room that a child with suspected measles has just left, because the virus can linger and remain infectious for about two hours.

In the current outbreak, 13 patients were under a year old and too young to be vaccinated, and 7 others were 12 to 15 months old, with parents who had not yet taken them for their first vaccination, which is due at 1 year. Sixteen others, who were older, came from families that refused vaccination. Fourteen more had what officials described as “unknown or undocumented vaccination status.” Only one person had proof of having received the standard two doses of measles vaccine.

In one family in Washington State, eight siblings came down with measles, and three of them had signs of pneumonia, a serious complication. The cases were reported after April 25 and are in addition to the 64 described by the disease centers on Thursday.

The eight children are believed to have contracted measles at a religious conference attended by about 2,000 people from 5 countries and 19 states. None of the eight had been vaccinated. Forty-eight states allow exemptions from vaccine requirements for religious reasons, and 21 for personal beliefs, the disease centers said.

Growing numbers of parents in the United States and other countries have begun refusing to vaccinate their children because of unproven fears that vaccines cause autism or other illnesses. Health officials blame the trend for the resurgence of measles in many areas. Israel, Switzerland, Austria, Ireland and Britain have had large outbreaks recently, linked to pockets of people who shun vaccination.

Given the outbreaks overseas, travelers need to be immunized, Dr. Schuchat emphasized, acknowledging that many people do not think of Europe or Israel as places where they have to worry about catching infectious diseases. Babies who are going to be taken on trips can be given a measles shots at 6 months instead of 1 year, officials said.

People who have not been immunized and have been exposed to measles can often be protected with a vaccination or treatment with immune globulin ― but the treatment must be given soon after the exposure. Health departments are supposed to track all the contacts of infected people and advise them about what to do, officials said.

Ten states have measles cases, although only seven have three or more cases, the disease center's definition of an outbreak. Besides New York City, the highest numbers are in Pima County in southern Arizona, with 15; and San Diego, with 11. The San Diego and Arizona cases have been traced to travelers from Switzerland. Cases in other states have come from Italy, India and probably China.

The other states with cases are Washington, Hawaii, Illinois, Michigan, Wisconsin, Pennsylvania and Virginia.

“I think it’s important for states who aren’t on that list to have their alerts up,” Dr. Schuchat said. “We know there are unimmunized people out there, and measles is extremely infectious. Not being on the list shouldn’t be reassuring.”

Before 1963, when the vaccine became available in this country, there were 3 million to 4 million cases of measles a year, and the disease killed 400 to 500 children and put 48,000 in the hospital. The vaccine wiped out transmission here in 2000, but the disease can easily be imported because there are still so many cases overseas. Worldwide, it still kills 242,000 children a year.

A report on the outbreaks is online at www.cdc.gov.

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Public health officials concerned over upswing in measles outbreaks
More than twice as many cases, including 12 in San Diego, have been reported nationwide so far this year than in all of 2007.
http://www.latimes.com/features/health/la-me-vaccine2-2008may02,0,6075407.story
By Rong-Gong Lin II, Los Angeles Times Staff Writer
May 2, 2008
The United States is on track to report its highest incidence of measles cases since 2001, exacerbated by a rise in outbreaks worldwide and by clusters of people who are opting out of the vaccine because of religious beliefs or fears of a purported link between the shot and autism, health officials said Thursday.

As of April 25, there were 64 reported cases of measles nationwide this year, including 12 in San Diego.

One in five cases required hospitalization, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the U.S. Centers for Disease Control and Prevention.

There were about 30 cases of measles in all of 2007.

Before the advent of federally funded vaccine programs in the last decade, outbreaks spread quickly among low-income children who lacked access to vaccinations.

"Now, I think we're seeing a different trend with communities or pockets of under-immunized children" that are more linked to vaccine exemptions, Schuchat said.

Measles is a highly contagious disease that can cause a rash, high fever, cough, runny nose and red watery eyes. It also can cause diarrhea, ear infections, pneumonia, brain injury, seizures and death.

Before the measles vaccine was introduced in 1963, there were up to 4 million reported cases and up to 500 deaths each year in the United States. But vaccination programs were so successful that public health officials declared widespread transmission of the disease eliminated in 2000.

The recent outbreak that infected a dozen children in San Diego underscores the concern of public health officials.

An unvaccinated 7-year-old boy who visited Switzerland brought the disease to his school in January.

Nearly 10% of the students at the San Diego Cooperative Charter School had received personal-belief exemptions from vaccinations.

The boy infected five children at his school, four at his doctor's office and his two siblings. All were unvaccinated.

A separate outbreak, centered in Tucson, spread after an adult visitor from Switzerland in February was hospitalized for measles and pneumonia.

As of Thursday, there have been at least 17 confirmed cases, and all had no records of vaccination. The outbreak is ongoing.

Measles cases are on the rise in New York City, with 22 cases reported in Brooklyn. Health officials have linked those cases to outbreaks in Europe and Israel.

Switzerland, for example, is facing its most severe outbreak in the last decade; 2,000 people have fallen ill in the last two years. The disease has spread especially rapidly in communities that believe in alternative medicine and avoid vaccination.

In Israel, 1,000 people have fallen ill since August in an outbreak that started among nonimmunized ultra-orthodox communities in Jerusalem.

In Los Angeles County, officials reported one measles case in April in which a preschool-aged child was hospitalized.

U.S. health officials are concerned about small but increasing numbers of parents who are choosing not to vaccinate their children.

At least 10 epidemiological studies have discredited theories linking the measles vaccine to autism, said Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia.

But the skepticism has had an effect: Of the 64 who have fallen ill in the United States this year, 63 had no records of vaccination. (The vaccine is 99% effective but can fail in a small number of cases.)

"As you start to see an erosion of confidence in vaccines and there are pockets of people choosing not to vaccinate, this is what you'll see," said Offit, a co-inventor and co-patent-holder of the vaccine for rotavirus. "Measles is not eliminated from the world."

Sizable outbreaks have hit nations in Europe where distrust of vaccines is stronger. Public skepticism rose sharply after a 1998 report in the medical journal Lancet linked the measles vaccine to autism.

The report's conclusion was retracted by 10 of 12 coauthors six years later, but, in the meantime, public confidence in the vaccine dropped and measles cases rose.

Though immunization rates are far higher in the United States, some researchers are concerned that trust is eroding among its residents as well.

In California, 1.11% of kindergartners had received personal-belief exemptions from vaccines in 2002; four years later, 1.41% of kindergartners had received such exemptions.

Though only 0.85% of Los Angeles County's kindergartners had personal-belief exemptions from vaccines in 2006, 1.56% received exemptions in Orange County, 2.06% in San Diego County, 3.07% in Santa Barbara County and 4.12% in Marin County in the Bay Area.

Despite overwhelming evidence by mainstream scientific organizations refuting a link between vaccines and autism, it remains a popular topic for some websites, some celebrities and Hollywood.

In January, ABC-TV broadcast its premiere episode of "Eli Stone," in which a lawyer wins a $5.2-million judgment after arguing that a mercury-based preservative in a vaccine triggered autism in a child. The American Academy of Pediatrics had urged the network to cancel the program.

In March, the U.S. Department of Health and Human Services' Division of Vaccine Injury Compensation agreed to pay an undisclosed amount to the family of a now 9-year-old girl whose parents said she showed autism-like symptoms after receiving a series of vaccinations as a toddler.

Vaccine critics say the case demonstrates a vaccine-autism link. But government officials say that the case makes no such concession, and that the girl had an extremely rare condition that most autistic children do not have.

Jenny McCarthy, a former Playboy model and actress who has written about raising an autistic son, has appeared twice on "Larry King Live" since September, arguing that vaccines trigger autism.

In her most recent appearance in April, McCarthy said, "This debate is over. Vaccines can trigger autism. . . . I've confirmed it."

Questioned on whether her conclusion was based on scientific or statistical evidence, McCarthy said, "I believe that parents' anecdotal information is science-based information."

Researchers say that is a wrong approach. Study after study has shown no link, they say.

A recent study of California children showed that autism rates continued to rise after most vaccine manufacturers in 1999 removed thimerosal, the mercury-based preservative in childhood vaccines that critics have targeted.

"It gets to the point where somebody is just wrong, and it's not only wrong, but it can potentially hurt their child or someone who sits next to that child," Offit said.

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