Four surprising vaccination statistics you haven’t heard before

January 26, 2012 · 27 comments

Here’s a quiz on infectious disease in the 20th century United States:

1. What percentage of the population died from measles in the years immediately before the measles vaccination was introduced?
a) 30%
b)3%
c)0.03%
d)0.00003%

2. What were the major causes for the declines of infectious disease mortality in the 20th century, in order of importance?
a) vaccinations, nutrition, antibiotics
b) antibiotics, vaccinations, public health measures
c) nutrition, public health measures, antibiotics
d) vaccinations, antibiotics, nutrition

3. What were the two major factors in decreasing infant mortality in the 20th century?
a) public health improvements and medical advances for low birth-weight babies
b) antibiotics and vaccinations
c) vaccinations and medical advances for low birth-weight babies
d) antibiotics and breastfeeding

4. At the time vaccinations were introduced, where did infectious diseases rank as causes of death in the U.S.?
a) 1
b) 3
c) 10
d) they weren’t in the top 10

Answers:

1. What percentage of the population died from measles in the years immediately before the measles vaccination was introduced?

d)0.00003%

Age adjusted deaths for vaccine-preventable disease per 100000

Age adjusted deaths for vaccine-preventable disease per 100,000

Note the different scale for polio on the right. Source: NBER Working Paper Series, Changes in the Age Distribution of Mortality over the 20th Century, D. Cutler and E. Meara, 2001

2. What were the major causes for the declines of infectious disease mortality in the 20th century, in order of importance?

c) nutrition, public health measures, antibiotics

Crude death rate for infectious diseases, United States 1900-1996

Crude death rate for infectious diseases, United States 1900-1996

Source: CDC, Achievements in Public Health, 1900-1999

“Early in the 20th century, mortality declines resulted from public health and economic measures that improved peoples’ ability to withstand disease.” Source: NBER Working Paper Series, Changes in the Age Distribution of Mortality over the 20th Century, D. Cutler and E. Meara, 2001

Note that rates of infectious disease didn’t change before vaccinations were introduced, but our ability to survive them did.

3. What were the two major factors in decreasing infant mortality in the 20th century?

a) public health improvements and medical advances for low birth-weight babies

“Between 1915 and 1960, post-neonatal mortality declined by 4.4 percent per year, compared to a 1.9 percent annual decline in neonatal mortality. Post-neonatal mortality is generally attributable to the infectious diseases . . . so this is consistent with the aggregate evidence on mortality change. Since 1960, however, most of the decline in infant mortality has been in neonatal mortality. In the 1960 to 1998 period, neonatal mortality declined by 3.5 percent annually, compared to 2.9 percent for post-neonatal mortality. Death in the first month of life is generally not a result of infectious disease. It is predominantly due to low birth weight and the adverse consequences of low birth weight for infant development.”

Source: NBER Working Paper Series, Changes in the Age Distribution of Mortality over the 20th Century, D. Cutler and E. Meara, 2001

Note that mass vaccination wasn’t introduced until 1963.

4. At the time vaccinations were introduced, where did infectious diseases rank as causes of death in the U.S.?

d) they weren’t in the top 10

Deaths by Major Causes, 1960–2009, Infoplease.com

I compiled these questions because it was information that completely surprised me. Vaccinations have saved lives, without question, but I don’t think on the magnitude we’re generally led to believe. This information shouldn’t lead us to a particular conclusion, but it should lead us to ask more questions. These are three I thought of:

1. Is mass vaccination of 100% of children, starting at birth, really the best way to save lives, especially when the vast majority of people are capable of surviving infectious disease?

2. Do we know why a small percentage of people (generally infants — although not all infant who contract infectious diseases will die from them) will die from infectious diseases? If we do, is there anything that can be done to target those vulnerable groups and increase their survival rate?

3. Do we know the big-picture impact of vaccination (either positive or negative)?

Was this information new to you? What questions does it bring up for you?

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