A Measles Death, Vaccines, and the Media's Failure to Inform

The Worst Outbreaks In U.S. History

The U.S. Has experienced many outbreaks over the last few centuries. These includes three waves of cholera and the 2020 spread of the SARS-CoV-2 virus.

An epidemic is defined by the Centers of Disease Control and Prevention (CDC) as a sudden increase in the number of cases of an infectious disease within a community or geographic area during a specific time period.

A spike in the number of cases of the same illness in an area beyond what health officials expect to see is an outbreak. The terms may be used interchangeably, though epidemics are often considered more widespread.

Over the years, many outbreaks of infectious diseases have occurred and spread across the United States.

Smallpox came to North America in the 1600s. Symptoms included high fever, chills, severe back pain, and rashes. It began in the Northeast and the Native American population was ravaged by it as it spread to the west.

In 1721, more than 6,000 cases were reported out of a Boston population of 11,000. Around 850 people died from the disease.

In 1770, Edward Jenner developed a vaccine from cow pox. It helps the body become immune to smallpox without causing the disease.

Now: After a large vaccination initiative in 1972, smallpox is gone from the United States. In fact, vaccines are no longer necessary.

One humid summer, refugees fleeing a yellow fever epidemic in the Caribbean Islands sailed into Philadelphia, carrying the virus with them.

Yellow fever causes yellowing of the skin, fever, and bloody vomiting. During the 1793 outbreak, it's estimated that the 10 percent of the city's population died and many others fled the city to avoid it.

A vaccine was developed and then licensed in 1953. One vaccine is enough for life. It's mostly recommended for those 9 months and older, especially if you live or travel to high risk areas.

You can find a list of countries where the vaccine is recommended for travel on the Centers for Disease Control and Prevention (CDC) website.

Now: Mosquitoes are key to how this disease spreads, particularly in areas such as Central America, South America, and Africa. Eliminating mosquitoes has been successful in controlling yellow fever.

While yellow fever has no cure, someone who does recover from the illness becomes immune for the rest of their life.

The United States had three serious waves of cholera, an infection of the intestines, between 1832 and 1866. The pandemic began in India and swiftly spread across the globe through trade routes.

New York City was the first U.S. City to feel the impact. Between 5 and 10 percent of the total population died in large cities.

It's unclear what ended the pandemic, but it may have been the change in climate or the use of quarantine measures. By the early 1900s, outbreaks had ended.

Immediate treatment is crucial because cholera can cause death. Treatment includes antibiotics, zinc supplementation, and rehydration.

Now: Cholera still causes nearly 95,000 deaths a year worldwide, according to the CDC. Modern sewage and water treatment have helped eradicate cholera in some countries, but the virus is still present elsewhere.

You can get a vaccine for cholera if you're planning to travel to high risk areas. The best way to prevent cholera is to wash your hands regularly with soap and water and avoid drinking contaminated water.

Scarlet fever is a bacterial infection that can occur after strep throat. Like cholera, scarlet fever epidemics came in waves.

Scarlet fever most commonly affects children ages 5 to 15. It's rare in children under 3. Adults who are in contact with sick children have an increased risk.

Older studies argue that scarlet fever declined due to improved nutrition, but research shows that improvements in public health were more likely the cause.

Now: There's no vaccine to prevent strep throat or scarlet fever. It's important for those with strep throat symptoms to seek treatment quickly. Your doctor will typically treat scarlet fever with antibiotics.

One of the biggest typhoid fever epidemics of all time broke out between 1906 and 1907 in New York.

Mary Mallon, often referred to as "Typhoid Mary," spread the bacterial infection to about 122 New Yorkers during her time as a cook on an estate and in a hospital unit.

About 5 of the 122 New Yorkers who contracted the illness from Mary Mallon died. The CDC cites a total of 13,160 deaths in 1906 and 12,670 deaths in 1907.

Medical testing showed that Mallon was a healthy carrier for typhoid fever. Typhoid fever can cause sickness and red spots to form on the chest and abdomen.

A vaccine was developed in 1911, and an antibiotic treatment for typhoid fever became available in 1948.

Now: Today typhoid fever is rare. But it can spread through direct contact with people who have the virus, as well as consumption of contaminated food or water.

H1N1 is a strain of flu that still circulates the globe annually.

In 1918, it was the type of flu behind the influenza pandemic, sometimes called the Spanish flu (though it didn't actually from come Spain).

After World War I, cases of the flu slowly declined. None of the suggestions provided at the time (wearing masks, drinking coal oil) were effective cures. Today's treatments include bed rest, fluids, and antiviral medications.

Now: Influenza strains mutate every year, making last year's vaccinations less effective. It's important to get your yearly vaccination to decrease your risk for the flu.

Diphtheria peaked in 1921, with 206,000 cases. It causes swelling of the mucous membranes, including in your throat, that can obstruct breathing and swallowing.

Sometimes a bacterial toxin can enter the bloodstream and cause fatal heart and nerve damage.

By the mid-1920s, researchers licensed a vaccine against the bacterial disease. Infection rates plummeted in the United States.

Now: Today more than 80 percent of children in the United States are vaccinated, according to the CDC. Those who contract the disease are treated with antibiotics.

Polio is a viral disease that affects the nervous system, causing paralysis. It spreads through direct contact with people who have the infection.

Outbreaks occurred regularly in the United States through the 1950s, with two major polio outbreaks in 1916 and in 1952. Of the 57,628 reported cases in 1952, there were 3,145 deaths.

In 1955, Dr. Jonas Salk's vaccine was approved. It was quickly adopted throughout the world. By 1962, the average number of cases dropped to 910. The CDC reports that the United States has been polio-free since 1979.

Now: Getting vaccinated is very important before traveling. There's no cure for polio. Treatment involves increasing comfort levels and preventing complications.

A major flu outbreak occurred again in 1957. The H2N2 virus, which originated in birds, was first reported in Singapore in February 1957, then in Hong Kong in April 1957.

It appeared in coastal cities in the United States in the summer of 1957.

The estimated number of deaths was 1.1 million worldwide and 116,000 in the United States.

This pandemic is considered to be mild because it was caught early. Scientists were able to develop a vaccine based on the knowledge from creating the first flu vaccine in 1942.

Now: H2N2 no longer circulates in humans, but it still infects birds and pigs. It's possible that the virus may again jump from animals to humans in the future.

Measles is a virus that causes fever, runny nose, cough, red eyes, and sore throat, and later a rash that spreads over the whole body.

It's a very contagious disease that spreads through the air. Almost all children caught measles prior to the vaccine. In the second part of the 20th century, most cases were due to inadequate vaccination coverage.

Doctors began to recommend a second vaccine for everyone. Since then, each year has typically had fewer than 1,000 cases, though this was surpassed in 2019.

Now: The United States has experienced smaller outbreaks of measles in recent years. The CDC states that unvaccinated travelers who visit abroad can contract the disease. When they come home to the United States, they pass it on to others who aren't vaccinated.

Be sure to get all the vaccinations your doctor recommends.

One of Milwaukee's two water treatment plants became contaminated with cryptosporidium, a parasite that causes the cryptosporidiosis infection. Symptoms include dehydration, fever, stomach cramps, and diarrhea.

An initial study indicated 403,000 people became ill and 69 people died, according to the Water Quality & Health Council, making it the largest waterborne outbreak in United States history.

Most people recovered on their own. Of the people who died, the majority had compromised immune systems.

Now: Cryptosporidiosis is still a yearly concern. The CDC reports that cases increased by 13 percent per year between 2009 and 2017. The number of cases and outbreaks vary in any given year.

Cryptosporidium spreads through soil, food, water, or contact with contaminated feces. It's one of the most common causes of illness to occur through summer recreational water use and can easily be spread from farm animals or in childcare settings.

Be sure to practice good personal hygiene, such as washing hands, when camping, or after touching animals. Refrain from swimming if you have diarrhea.

In the spring of 2009, the H1N1 virus was detected in the United States and spread quickly across the country and the world. This outbreak made headlines as the swine flu.

The CDC estimates that there were 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths in the United States.

Globally, 80 percent of this outbreak's deaths were estimated to have occurred in people younger than 65.

In late December 2009, the H1N1 vaccine became available to everyone who wanted it. Virus activity levels began to slow.

Now: The H1N1 strain still circulates seasonally, but it causes fewer deaths and hospitalizations. Influenza strains mutate every year, making the previous year's vaccinations less effective. It's important to get your yearly vaccination to decrease your risk for the flu.

Pertussis, known as whooping cough, is highly contagious and one of the most commonly occurring diseases in the United States. These coughing attacks can last for months.

Infants too young for vaccination have the highest risk for life-threatening cases. During the first outbreak, 10 infants died.

A whooping cough outbreak comes every 3 to 5 years. The CDC reports that an increase in the number of cases will likely be the "new normal."

Now: The occurrence of the disease is much less than it was. The CDC recommends all people need the vaccine, but that pregnant women get a vaccination during the third trimester to optimize protection at birth.

It's also recommended that all children, and anyone who hasn't previously been vaccinated, get the vaccine.

First documented in 1981, the epidemic known today as HIV appeared to be a rare lung infection. Now we know that HIV damages the body's immune system and compromises its ability to fight off infections.

AIDS is the final stage of HIV and, according to the CDC, in 2018 it was the 9th leading cause of death in the United States among people 25 to 34 years old. Just because a person gets HIV doesn't mean they'll develop AIDS.

HIV may be transmitted sexually or through blood or body fluids from person to person. It can be transmitted from mother to unborn baby if not treated.

Pre-exposure prophylaxis (or PrEP) is a way for high risk populations to avoid HIV infection before exposure. The pill (brand name Truvada) contains two medicines that are used in combination with other medicines to treat HIV.

When someone is exposed to HIV through sexual activity or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.

The CDC believes that for the first time in modern history, the world has the tools to control the HIV epidemic without a vaccine or cure, while laying the groundwork to eventually end HIV.

Controlling the epidemic requires reaching high risk groups with treatment and prevention.

Now: While there's no cure for HIV, transmission risk can be decreased through safety measures, like making sure needles are sterilized and having sex with barrier methods.

Safety measures can be taken during pregnancy to prevent the syndrome from being transmitted from mother to child.

For emergencies, PEP (post-exposure prophylaxis) is a new antiretroviral medicine that prevents HIV from developing within 72 hours.

The SARS-CoV-2 virus, a type of coronavirus that causes the disease COVID-19, was first detected in Wuhan City, Hubei Province, China in late 2019. It seems to spread easily and sustainably in the community.

Cases have been reported all over the world, and as of late May 2020, there were over 1.5 million cases and over 100,000 deaths in the United States.

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Also, visit our coronavirus hub for more information on how to prepare, advice on prevention and treatment, and expert recommendations.

The disease can be life threatening, and older adults and people who have preexisting medical conditions, like heart or lung disease or diabetes, seem to be at higher risk for developing more serious complications.

Primary symptoms include:

fever

dry cough

shortness of breath

fatigue

Education

Educating yourself about current disease outbreaks can help you understand what precautions you should take in order to keep you and your family safe and healthy.

Take the time to search for ongoing epidemics by visiting the CDC's Current Outbreak List, especially if you're traveling.

Protect yourself and your family

The good news is that most outbreaks listed here are rare and, in some cases, preventable. Make sure your family is up to date on their vaccinations before traveling, and get the latest flu vaccines.

Simple steps in the kitchen and food safety techniques can also prevent you and your family from contracting or transferring infections.

The History Of The Polio Vaccine

© Provided by Discover Magazine

On April 12, 1955, virologists announced that they'd developed a safe and potent vaccine against polio, the deadly, paralyzing disease that then tormented thousands of individuals in the U.S. Setting off a series of concentrated vaccination campaigns in the country and abroad, the announcement sowed the seeds for a polio-free future.

Today, 68 years after the arrival of the vaccine, the disease teeters on the verge of disappearance. In the U.S., cases of wild, community-circulating polio were wiped out in the 1970s, and since then, they've been banished from almost all corners of the world.

So, in honor of its April announcement, here's what you'll want to know about the history of the polio vaccine.

The Plague of Polio

Though the virus that causes polio has circulated throughout human history, it wasn't until the 1900s that the poliovirus prompted seasonal spates of infections. The first of these outbreaks to occur in the U.S. Took place in Vermont in the 1890s, infecting 132, paralyzing 58, and killing 18. And waves of worse outbreaks only followed, troubling the population (and particularly the young) for the next 60 years or so.

The reason for the sudden onset of these seasonal, summer outbreaks remains a mystery. Some specialists see the creation and circulation of stronger strains of the poliovirus as the culprit. Others credit improving sanitation systems in the U.S., which prevented people from increasing their immunity to the virus in their infancy.

That said, regardless of the reason, the sudden appearance of an annual polio season was devastating. In 1952, the single worst wave of the disease infected 60,000 individuals in the U.S., many of whom were left with canes, crutches, wheelchairs and full-body breathing apparatuses called "iron lungs" in the aftermath of the surge.

With polio ravaging the population and no cure in sight, an assembly of specialists supported by the National Foundation for Infantile Paralysis set out to fight the virus with vaccines. By that time, the notion of fending off a virus with vaccines was nothing new. But producing a vaccine against polio was still a tricky task, requiring an intimate knowledge of the transmission of the virus.

Read More: Learning From the World's Worst Diseases

The Pathology of Polio

Polio, or poliomyelitis, is an intestinal infection caused by the poliovirus, which passes from person-to-person through the ingestion of the feces of an infected individual.

The infections are mostly mild, involving symptoms such as fever, fatigue and nausea. But in around 1 in 200 infections, the virus travels to the nervous system, where it destroys the neurons that direct muscle movement. When this occurs, the virus can cause permanent paralysis and sometimes death, whenever the muscles within an individual's airways are adversely affected.

Throughout the 1940s, researchers learned a lot about the poliovirus. In 1949, a team discovered that there were three types of virus in circulation, including PV1, PV2 and PV3, which would need to be targeted and treated by a vaccine on an individual basis. That same year, another team discovered that these three types of virus could all be cultivated artificially, which would supply a stream of poliovirus, safely and consistently, from which a potential vaccination could be created.

Read More: The Deadly Polio Epidemic and Why It Matters for Coronavirus

Salk's Polio Vaccine

Armed with the knowledge of the three types of poliovirus, as well as a steady supply of all three, American virologist Jonas Salk developed the first promising vaccine against polio in 1952. After several small trials, the vaccine was tested in the Francis Field Trial, which was then the most massive medical field test in the U.S.

Named after Thomas Francis, the administrator of the test, the trial involved almost 2 million individuals who received injections of a vaccine or a placebo, or who received nothing at all. After observing the participants to determine whether the vaccine reduced their chances of contracting polio, Francis concluded in April 1955 that the vaccine was 60 to 70 percent effective against PV1 and 90 percent effective against PV2 and PV3.

Breaking from the traditional process of vaccine development, Salk's vaccine did not contain any active strains of the virus that it intended to defeat. Instead, it contained only inactivated strains of the virus, incapacitated by formaldehyde, which could induce antibodies without inducing infection. As one of the first pioneers of this type of vaccine, Salk was convinced that these strains were as potent as active strains, but much more secure when included in vaccinations.

The results of the trial inspired the immediate approval of the vaccine. Soon, millions of vaccinations were transported throughout the U.S., where they were distributed, first and foremost, to the "polio pioneers" who participated in trials without receiving doses of the drug themselves. Following this initial wave of vaccinations, infections dipped, and deaths decreased by 50 percent after a single year.

Sabin's Polio Vaccine

Within two years of the announcement, annual infections from polio plummeted to around 5,600 in the U.S. Within six years of the announcement, infections plunged to 160. This additional drop in infections was due to the development of an alternative, active version of the vaccine, developed by virologist Albert Sabin and made available to the public in 1961.

While Sabin acknowledged that the inactive strains included in Salk's vaccine could induce antibodies temporarily, the virologist thought that an active virus was required to raise antibodies that really stuck around. As such, Sabin studied an assortment of active poliovirus variants, searching for strains which were too weak to cause serious symptoms but were strong enough to evoke an enduring antibody response.

By 1961, Sabin found three of these attenuated strains, and incorporated them in an active vaccine for polio. Administered orally, by being dropped onto the tongue or infused in sugar, Sabin's active vaccine was simple and affordable to administer. Once approved, it immediately supplanted Salk's injected vaccine, becoming the most popular method of protection against polio in the U.S.

Polio Vaccines in the U.S.

Throughout the virologist's career, Sabin insisted that the chances of contracting paralytic polio from an active vaccine were minimal. But despite Sabin's ideas, almost 110 cases of vaccine-associated polio arose in the U.S. Between 1980 and 1992, occurring when the weakened virus incorporated in the vaccine regained its virulence after ingestion.

In response to these infections, the U.S. Returned to the inactive vaccine in 2000. Since then, all vaccines administered against polio in the country have been inactive, completely removing the risk of contracting vaccine-associated polio.

Read More: What Would Happen If We Didn't Have Vaccines

How The Polio Epidemic Revolutionized Modern Medicine

Modern ventilation in medical care has a surprising origin story in Denmark. (Nathan Denette/The Canadian Press)

The Current23:17How the polio epidemic lead to the creation of the modern ICU

Read transcribed audio

The year was 1949 and polio was raging across the United States. 

By 1952, the epidemic had spread around the world, and Copenhagen, Denmark, was feeling the toll as autumn began. More than 3,000 people were admitted to hospital, and patients were wheezing and gasping for breath. Some were paralyzed.

The doctors and nurses there could do very little to help.

The Autumn Ghost is a book by Hannah Wunsch. (Greystone Books)

"For the unlucky few, and it was usually less than about five per cent of those who got the disease, they would develop paralysis — the virus would actually go to the nerves of the spinal cord and cause weakness of limbs," Dr. Hannah Wunsch told The Current host Matt Galloway.

"If you were really unlucky, [you had] a weakness of the muscles of respiration, and if you were truly unlucky, the muscles that control things like swallowing, which was called bulbar polio."

Wunsch is a critical-care physician and researcher at Sunnybrook Health Sciences Centre in Toronto. Her book, The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care, explores how polio in Denmark forced medical professionals to rethink critical care. 

"There was this epidemic in Copenhagen, which was really the moment in time when they figured out how to provide what's called 'positive pressure ventilation' — modern ventilation to patients who had polio," Wunsch said.

"This really was the impetus for the development of modern intensive care.... So, as an intensive-care physician, I was really interested in it because it's really my origin story for my specialty."

Patient care

In her book, Wunsch traces how the devastating effects of the polio epidemic would create the impetus for modern ventilation systems. Ventilators, which allow patients with respiratory trouble to breathe, were crucial medical equipment during the height of the COVID-19 pandemic. 

There was about a 90 per cent mortality, so they were up against a wall- Dr. Hannah

"We take for granted that these things exist: intensive-care units, mechanical ventilators, all the gadgets and things we can do to people," she said. "There was a time before that, and that's why this epidemic is special, because it was that turning point."

Before the polio vaccine was created in 1955, treatment for severe polio cases was only available through the use of an iron lung — a large respirator that encloses most of the patient's body and helps to stimulate breathing during paralysis. During the peak of the crisis, Copenhagen only had one iron lung.

But even with all the iron lungs in the world, the machines would not prove useful. 

"They were admitting towards the end of August about 50 patients a day, and many of them had bulbar polio — they had already seen dozens of deaths," Wunsch said. "They also knew that even if they had iron lungs, bulbar polio was not really helped by iron lungs.... There was about a 90 per cent mortality, so they were up against a wall."

Finding solutions

In this moment of crisis, anesthesiologist Dr. Bjørn Aage Ibsen had an idea. 

"He was an incredibly smart man and perceptive," Wunsch said. "[He] was the one who really proposed this breakthrough in care that came about, which was the idea that rather than trying to suck the lungs open, why not push air into the lungs the way they often did for patients in the operating room?"

Polio wards were lined not only with beds, but with iron lungs, large metal ventilators that helped patients to breathe during the worst of the infection. Some survivors never regained lung function and spent the rest of their lives in the devices. (U.S. Food and Drug Administration) Ibsen would apply the same tactics used in surgery to care for patients suffering from respiratory failure.

As It Happens

This lawyer is one of the last people alive who still uses an iron lung

"He was just very experienced with keeping people alive in the operating room, and that was because he would give them general anesthesia, he'd paralyze them, and then he'd have to breathe for them," Wunsch said.

"The main problem for these polio patients [was] they just weren't breathing well enough, and that if he could both 'protect the airway,' meaning not allow those secretions in the back of the throat to get into the lungs, and also allow them to breathe ... That this would potentially solve the problem."

Vivi Ebert, a 12-year-old girl with bulbar polio, would be the first patient to undergo this procedure. 

"He took over her care and he demonstrated after a kind of a rocky start that he could, by blowing air, kind of hand ventilating her, keep her alive, as he did with people in the operating room, and so this was pretty kind of miraculous." Wunsch said. 

But, without the benefit of mechanical ventilators at the time, it wouldn't be feasible to have doctors ventilating the patient 24 hours a day. Ibsen would enlist medical students at the University of Copenhagen to hand ventilate all day and all night.

"They had six eight-hour shifts with a 10-minute break each hour for cigarettes, and they had really no end in sight.... They did this for weeks and then months as they realized that this worked, they were keeping people alive," Wunsch said.

"It's an exciting story in that it's about people coming together in a city."

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