Measles is spread by respiratory infection, and is incredibly contagious by that route, so measles incidence isn’t much affected by sanitation. Measles mortality (the case fatality rate) was probably a little improved by sanitation because there would be some impact from water-borne secondary infections, but again most of the measles mortality was more related to respiratory than water-borne infections.

As I say, it’s surprising, but sanitation was probably only one of a myriad of factors that helped reduce measles case fatality rates, and was far from the most important of them.

Why do you say that? I’m a firm believer in water sanitation because I work at both a water filtration plant and a waste water plant. All the research I’ve done leads back to four factors; 1)water, 2)food nutrition and rotting food, 3)access to medical care, and 4)personal hygiene.
These factors are huge and simply cannot be ignored. I believe to ignore them is an attempt to hide them.

Sanitation had surprisingly little to do with the amazing drops in measles mortality in the early to mid 20th century. The full reasons remain unclear but nutrition, crowding, and probably (in Europe) demographic changes related to WWII probably were the most important.

What was really important was the separation of water and wastewater streams in large cities. Although wastewater treatment would lag by several decades (with interesting public health effects in its own right), it’s HIGHLY instructive to view the trend in infectious disease mortality and life expectancy, particularly in infants in the decades, after drinking water disinfection was introduced.

It can be argued that the US general populace nutrition suffered with early 20th c. urbanization because of the lack of transportation infrastructure, other than rail. Recall that the Haber process and major farming mechanization didn’t make cheap agrochemicals available until after the mid 1930s.

They clearly show a drop from 10,000 to 100 before the measles vaccine in 1968.

More than 1,500 people die from Asthma. Research shows that the chances of developing asthma reduces significantly as a baby delays vaccination from 2 months to 4 months.

The issue of measles in developing countries is a very complex one. The headlines a few years ago were ‘Measles vaccine program has reduced measles cases by 90% says the WHO’. Amazing?

But when you really look you find many contributing issues. For example, research shows that Drs over diagnosed measles by up to 70% and data was taken from Drs before vaccine, but after the vaccine measles cases had to be confirmed by lab reports and hundreds of new units were set up. Also, that vitamin A is given with the vaccine in many parts of Africa (vitamin reduces measles mortality by 50%.)

One thing I think most folk would agree upon is that dirty water is the one of the leading cause of death in developing countries and kills ten times more than measles, yet ten times more is spent on the measles vaccine program compared to clean water initiates.

By far the most important reason was nutrition. Childhood nutrition (and childhood quality of life) really started to improve around the turn of the century, and nutrition is an enormous factor determining measles survival. This is still hugely relevant today; measles case-mortality rates in Africa are much higher than in the US or UK, for example, and nutrition status is the major predictor. American children in general had better nutrition than British, and that helps account for the earlier drop in measles mortality in the US.

Another reason was better nursing care — or, more accurately, getting rid of actively harmful nursing care. Blood-letting and similarly drastic “treatments” accounted for a fair number of childhood deaths in the early 20th century. Sanitation — reducing exposure to other diseases — was another important factor; measles is a potent immune-suppressive disease and many measles deaths are due to secondary infections, so reducing exposure to bacteria and other viruses was literally a life-saver. And, though I don’t have real evidence of this, I think a more formal approach to quarantine probably was important as well. That shifted the age of exposure up a little by protecting the youngest children, and it was mainly the very youngest children who died of measles. (it’s also argued that other factors caused measles to increasingly infect a slightly older population, including reduced family size and so on.)

It’s important to note, though, that while the death rate did drop it had pretty much plateaued in the early 1950s — there was little or no further improvement in death rate for a decade before the vaccine was introduced, after which there was another precipitous drop in deaths that paralleled, this time, the drop in case number.

I don’t think anyone argues that vaccines alone have been the cause for all diseases and all death reduction — I’ve tried to make that point in this blog several times, especially when talking about tuberculosis. Sanitation, nutrition, antibiotics, and quality of care are all parts of the story. But if you follow through measles death rates in multiple countries — I’ve shown data for China, Finland, Burkina Fasso, Mali, and Togo, as well as the US and the UK, introducing the vaccine at different times — measles vaccination has led to a rapid and dramatic drop in measles cases and in measles deaths.

Anyway, what I wanted to ask you about was this: What do you make of this chart, from a UK NHS site, that pretty clearly shows that while reports of measles cases fell dramatically following the vaccine, measles deaths HAD fallen from more than 1000 in 1941 to around 100 (? hard to tell from scale) in the mid-1960s, just before the vaccine.

When I show this to my beloved relative, she will certainly point out to me that UK NHS data prove that measles deaths fell by more than 90% before the introduction of the vaccine.

How would you advise that I respond to her?

Here is the link:

http://www.hpa.nhs.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733756107