Health Wanted: Sugar

The Episode

Valentine’s day is here, and with it, mountains of sweets! Boxes of chocolates! Candy hearts that somehow still have phrases like “fax me!” There’s no limit to confectioneries for your cutie pie, but what does the research say about our sweet tooth’s connection to our overall health? This week on Health Wanted, we’re talking sugar, sugar.

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The Listener Questions

Does vaccination reduce the risk of SSPE if you get measles after you’ve been vaccinated?

The short answer is very likely yes, but because there are so few cases already it’s hard to get to statistical significance. 

SSPE is short for subacute sclerosing panencephalitis. It is a complication of measles infection that can take years to develop, where some of the virus invades the central nervous system and then reactivates two to ten years after recovery from the initial infection. It’s always fatal.

Since we eliminated measles in 2000 thanks to vaccines, SSPE, which was already rare, has become exceedingly rare. With cases on the rise, that is something we’re likely going to see again in the future.

There was a real spike in measles cases from 1989-1991, which is what caused us to recommend two vaccines instead of one. It was found that the risk of SSPE in people who got infected during that period was seven to 11 cases for every 100,000 infections.

There was, unfortunately, a case of SSPE recently in a child in California who got measles too young to be vaccinated. But there are no current reports of SSPE in someone who was fully vaccinated.

A study from 1983 looked at cases of SSPE between 1968 and 1979 and found that cases were significantly lower in the vaccinated population and that cases could potentially be explained by vaccine failure or by kids having gotten a subclinical measles infection before they got the vaccine. This would all be from people who were vaccinated when the standard was one dose.

A Morbidity and Mortality Weekly Report from 1982 looked at 368 cases of SSPE from 1968 to 1989, and the estimated the rate of SSPE after infection was eight per million cases. The risk of SSPE after vaccination between 1963 and 1974 was 0.7 per million doses of vaccine. But again, vaccinated in this case means one dose.

You might be wondering why the rates are so much higher after the late 80s outbreak, and it was probably because of better identification of cases. The cases from the 70s may very well have been underreported.

So it really does seem that breakthrough infections are much more protected from SSPE than people who get the full brunt of a measles infection. Which makes sense, because breakthrough infections tend to be milder anyway.

Is the current U.S. measles outbreak domestic or foreign in origin?

In 2000, the World Health Organization declared measles eliminated in the United States. This does not mean there was no measles in the U.S., but that there was no sustained transmission of the virus over a period of 12 months. So there were still cases every year, but usually less than 100. They were not able to spread to a huge number of people and burned out quickly.

The outbreaks now are domestic, because the virus is being passed from citizen to citizen.

If you’re asking if the so-called "patient zero” who started the current outbreak was themselves infected by someone in the U.S. or abroad, that’s a little trickier.

We know that both the West Texas outbreak (which was initially concentrated in the Mennonite community) and the outbreak in South Carolina (which has greatly affected a Slavic community there) likely began within these groups because they are close knit and have low vaccination rates. Was the person who introduced the disease to each population infected by another citizen? Were they infected after contact with someone who was foreign born? Or someone who had traveled internationally recently? By a foreign visitor? If we know that answer, it has not been shared by health authorities.

What’s more important is that these outbreaks are happening because there’s such low vaccine uptake.
If we had vaccine coverage of 95% then the virus would die out quickly because there would be so few susceptible people. So, I personally worry less about where the measles cases are coming from and more about how we stop them from spreading.

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