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According to this article, most of the drop in the measles death rate occurred in the United States prior to the introduction of vaccines because of better health care and nutrition.

That fact is quoted here and summarized provocatively as,

Note that even in the ABSOLUTE WORST CASE, which is a completely unvaccinated scenario with 90 percent infection rates that assumes absolutely no improvement in health care in 55 years, we're talking about 450 deaths per year. Realistically, we're probably talking around 200, given the advancements in medical technology. THAT is what all the pro-vaccine scaremongers are going on about. Americans would do better to ban bicycles, as they would save three times more lives per year.

Is that true?

Given modern health care and nutrition, is the health risk of measles without vaccines comparable to the dangers of bicycle riding in the United States?

That seems a surprising statistic given the fervor behind the recent measles outbreak.

ChrisW
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Lepidopterist
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  • Is your question about the factoid stated in your title (i.e. measles deaths pre-1960 as reported in the Journal), or, is it about the claim in the last paragraphs (i.e. whether that facts reported in the Journal justify the claim made in the provocative summary that the measles aren't dangerous and that vaccines don't save lives)? Because I think that the logic/argument in the "provocative summary" is wrong, but that's irrelevant if the summary is irrelevant and your question is (only) about the article in the Journal. – ChrisW Feb 05 '15 at 02:08
  • My question is whether the claim that measles deaths given modern health care and nutrition (without vaccines) are comparable to the dangers of bicycle riding in the United States. – Lepidopterist Feb 05 '15 at 02:41
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    I edited to ask about the second claim instead of asking about the first claim: I hope that's closer to what you want to ask about. – ChrisW Feb 05 '15 at 02:52
  • Ok, that's fine. – Lepidopterist Feb 05 '15 at 03:06
  • If we're talking strictly morbidity, the wording could be better than comparing "health risk". Measles (and bicycles, I suppose) can cause several health related problems beside death. – Is Begot Feb 05 '15 at 03:24
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    @Geobits I agree, and that's why "death" is IMO a disingenuous argument in the notable claim. In [this comment](http://skeptics.stackexchange.com/questions/26656/would-measles-be-no-great-health-risk-in-the-us-even-without-vaccines#comment97906_26656) the OP said he wanted to compare "the dangers", so I thought I was justified in phrasing that as "health risks" and thus allowing answers to address any/other risks also. Another ambiguity is that the claim is to do with "measles", whereas the vaccine is for "MMR" which includes 'german' measles (rubella), which can cause important birth defects. – ChrisW Feb 05 '15 at 03:45
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    Bicycles provide fitness/health benefits, transport (and a corresponding decrease in motor vehicle traffic) and are considered fun. If they *didn't* provide these benefits (and if motor vehicles didn't provide benefits) it is arguable that they *would* be banned. Deaths due to vaccine-preventable disease = bicycle-related deaths is a false equivalence. – Oddthinking Feb 05 '15 at 05:18
  • The fact that each disease was being eliminated exactly in conjunction with the introduction of the vaccine (sometimes staggered by years) makes those diseases pretty tricky! – JasonR Feb 05 '15 at 12:54
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    200 deaths a year versus zero deaths a year is a pretty significant contrast. – Zibbobz Feb 05 '15 at 15:36
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    The number of traffic casualties caused by bicycles is very close to zero. Almost all lethal traffic accidents are caused by cars. Therefore, the obvious response is [to ban cars](http://www.banthecar.com/), not to ban bicycles. – gerrit Feb 05 '15 at 16:42
  • Why am I getting downvoted for this question? It is a sincere question motivated by a desire to understand the true benefits of the vaccine. I agree that brain damage, etc, is something serious that should be counted when discussing the dangers of measles. Death is not the only issue. But I have often seen measles vaccines credited with much more reduction in fatality than is cited here. – Lepidopterist Feb 05 '15 at 18:13
  • And the MMR vaccine versus just the Measles vaccine is a distraction from my question. I didn't ask about MMR! – Lepidopterist Feb 05 '15 at 18:14
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    You are probably being downvoted for citing an obviously biased source for the claim. Generally blogs that insult people who support an opinion will draw hate from those that support the insulted opinion. – Waterseas Feb 05 '15 at 19:24
  • I agree it's biased! My question is whether the conclusions therein are true or not. I am trying to assess the health risks to the US population of not getting a measles vaccine. I have often encountered people saying that the measles vaccine has saved many many more lives than this blogger is claiming. – Lepidopterist Feb 05 '15 at 19:27
  • This also misses the point of the economical burden. Currently it's around average of $20K-$30K per case. Without vaccines there where 542K cases per 170M, so adjusting for population growth and greater density, today if vaccines didn't exist it would have been 1.0M-1.5M cases. That would costs health system $45B. – vartec Feb 06 '15 at 23:24
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    Something else here: What's the opposing risk? Where are the anything like 200 deaths/year from vaccines? I can't even find a death rate for the vaccine, the most serious side effect reported is under 1/million--which would translate to 1-2 cases/year. – Loren Pechtel Feb 07 '15 at 04:18
  • And another factor--would the death toll actually be lower now? There are more people around with compromised immune systems now (people that would have been dead back then) to be seriously hurt by it. – Loren Pechtel Feb 07 '15 at 04:23
  • I know one is supposed to report only "documented truth" on this website, but I still want to share my experience. I've had measles like 20 years ago. And so did my brother, parents, cousins, uncles, friends etc. None of them had complications. I've never heard of anyone with complications. Am I mistaking measles for some other illness? Or has the virus strengthened since then? – algiogia Mar 20 '15 at 13:50

1 Answers1

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There's no way to know for sure what the toll of a modern measles outbreak in the US would be. However, it seems the author of that article used only the facts that would support his case. The article he cites when coming to his conclusion is Measles Elimination in the United States.

First, the numbers he uses from 1956-1960:

Not all cases were reported to the public health system; from 1956 to 1960, an average of 542,000 cases were reported annually.By the late 1950s, even before the introduction of measles vaccine, measles-related deaths and case fatality rates in the United States had decreased markedly, presumably as a result of improvement in health care and nutrition. From 1956 to 1960, an average of 450 measles-related deaths were reported each year (∼1 death/ 1000 reported cases)...

So we have 450 deaths from 542,000 reported cases, or 0.83/1000. This is where the article gets the 450 number, claiming this represents the worst case scenario, since public health and medicine has gotten better.

However, it completely ignores a more recent outbreak pointed out in the same paper:

Nevertheless, a resurgence of measles occurred during 1989–1991, again demonstrating the serious medical burden of the disease. More than 55,000 cases, 123 deaths, and 11,000 hospitalizations were reported.

By the logic used, the death rate should have been lower after ~30 years, due to advances in medicine. Instead, we have 2.24/1000, not quite three times the rate in the late 50s.

Of course, these numbers could be a bit off, since they are using the number of reported cases, but it seems clear that the author found the one number that supported his point and didn't bother with the others (and just pulled 200 from nothing but an unfounded assumption).

As for bicycles, the number most often used is probably the 677/year, reported by the NHTSA for 2011:

A total of 677 pedalcyclists were killed in motor vehicle crashes in 2011.

However, I think it's important to note that as gerrit commented, that number is specifically for motor vehicle crashes. I can't find a number for how many deaths are caused by bicycles per year, but my assumption is that it's much lower.

It also ignores that far more people ride bicycles in the course of a year than contract measles (even before vaccines). The National Bicycle Dealers Association has this to say:

35.6 million Americans age seven and older were estimated to have ridden a bicycle six times or more in 2013, according to the National Sporting Goods Association. This number was down 9.4% from 2012 that had 39.3 million participants. The peak participation year was 1995, with 56.3 million participants. It should be noted that the age limit on this number eliminates millions of young people who ride bicycles with wheel sizes 19" and under. It also does not count those who rode a bicycle fewer than six times in the year.

Taking these numbers at face value, bicycles have a death rate of 0.02/1000, which is about 40 times lower than measles. While the true number of bicycle riders may be a bit above or below that estimate, the rate is nowhere close.

Of course, as mentioned in the comments, this is only the death rate. There are other complicating factors (20% hospitalization rate in 1989-1991, for example), which I believe makes this a false comparison at best.

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Is Begot
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    +1: You do well to point out that death is certainly not the only consequence of measles. It's like if they had a vaccine that prevented all strains of flu. Flu usually doesn't kill, but wouldn't you like to have back all the time you've been sick with the flu over the course of your life? – Vivian River Feb 06 '15 at 18:33