The French Paradox: How A Nation with A 90% Vaccination Rate Has A Measles Epidemic.

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The Journal of Internal Medicine reported that the U.S. had a bumper crop of measles cases this year.  118 cases.  89% of those were imported in from other countries.  Evidently the French had about 10,000 cases already this year. 

I’d always been under the impression that the French vaccinated.  Maybe in a French, more laid back manner, but I thought it actually happened.  So I went looking around at the reporting of French vaccination.  It appears from the journals that 90% of the children under 2 years had been vaccinated in 2007.  (I’ve included the abstract below.  U.S. rates vary 92-98%)  But another study of the French military found that only 30% of those who contracted the disease had been vaccinated (Eur J Clin Microbiol Infect Dis. 2011 Feb 12).

The most disturbing article was on French adults who contracted the disease.  The healthcare workers had overwhelmingly been fully vaccinated and still contracted the disease. (see my website for data).  The Canadian experience of  epidemics has been that the ability of the vaccine to protect ranges from 66-88% for two doses, which is consistent with other epidemics. 

As the number of cases rises, there is the obvious attack on those darn resistant parents who are putting their children at risk.  But evidently the French military didn’t feel it necessary to vaccinate either.  Another study found that only a third of French infectious disease doctors had been checked to see if they had measles antibodies.  Parents who are resistant to measles vaccination are not the sole cause of this epidemic. 

In the U.S. last year’s cases of measles were associated with resistant parents combined with importation, but the number of cases is suprisingly low if we are to believe the “resistant parents cause this problem” hypothesis.  In comparison to the 92 to 98 percent vaccination rates for children (from the “resistant parent” Indiana outbreak statistics), the documented vaccination rate for healthcare workers during the recent outbreak in Tucson, Arizona was 75%.  Of those individuals, 9% showed up negative for measles antibodies.

In short, the large institutional risk (French military or Arizona hospitals) of transmission far exceeds the susceptibility of transmission due to resistant parents.  Periodically we have outbreaks in the U.S., and they overwhelmingly make the press froth about parents needing to vaccinate.  But we have extraordinary compliance with almost all parents.  The outbreak in France right now is being transmitted by susceptible adults and previously vaccinated children.  It is not justification for a mandatory vaccination program. 

In Singapore, where they have mandatory vaccination, they still experience periodic outbreaks of measles.  Their response is to blame parents who have not kept vaccine records current.  A more comprehensive look at the periodic outbreak issue would be to examine the reality that vaccination will never be 100% effective and to focus our attention on areas of the world where measles is widespread, epidemic, and deadly due to other health issues. 

Euro Surveill. 2010 Sep 9;15(36). pii: 19656.

Spotlight on measles 2010: update on the ongoing measles outbreak in France, 2008-2010.


French Institute for Public Health Surveillance, Saint-Maurice, France.


Since early 2008, France has been experiencing a measles outbreak with almost 5,000 notified cases as of 30 June 2010, including three measles-related deaths. The proportion of cases 20 years or older reached 38% during the first half of 2010. This situation is the consequence of insufficient vaccine coverage (90% at age 24 months in 2007) that led to the accumulation of susceptibles over the last years. It underlines the need for additional measures targeting susceptible children and young adults.


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