Re-Emerging Diseases: Why Some Are Making a Comeback

In the past century or so, humans have fought—and won—their fair share of battles with disease. Vaccines defeated smallpox. Antibiotics conquered scarlet fever. And insecticide scaled back mosquito-borne illnesses.

Despite these successes, some diseases appear to be making a comeback. Outbreaks of measles and mumps have made more than a few headlines of late, and once-lost pathogens like cholera are creeping back into medical histories. While the reasons behind the rise and fall of diseases are often complex and difficult to pin down, here are a few key reasons behind some of these resurgences.

Vaccine Refusal

One of the greatest public health achievements in history, vaccines are credited for the massive decline of potentially dangerous diseases like measles and polio. Although the majority of families embrace vaccination, a growing number appear to be delaying or forgoing vaccines altogether due to a misunderstanding of the safety, effectiveness, and necessity of vaccination.

Measles is one of the most contagious diseases known to mankind. It was officially declared eliminated in the United States in 2000, but since then, dozens of outbreaks and thousands of cases have been reported—including an outbreak involving Disneyland that led to more than 300 cases in the United States and Canada.

According to a review published in JAMA, high numbers of vaccine refusers in a given community increases the risk of measles not just for unvaccinated individuals, but for vaccinated people, too. That's because no vaccine is 100 percent effective. Some people who receive the vaccine might not respond to it and could get sick anyway if they are exposed to the virus.

Waning or Insufficient Immunity

Measles isn't the only vaccine-preventable disease seeing a resurgence. Cases of pertussis and mumps have also been on the rise, and while vaccine refusal is certainly a factor, there's another culprit potentially at play: insufficient or waning immunity.

Many of the individuals involved in recent outbreaks of mumps and pertussis have been at least partially vaccinated. Does that mean that the vaccine doesn't work? Not exactly.

Pertussis and mumps vaccines are about 80 percent effective when they're first given. As time goes on, however, research suggests that that immunity wanes, and more doses might be needed to protect against outbreaks.

Vaccines work by training your body to fight a particular pathogen, like a virus, bacteria, or toxin. The immune system creates antibodies to fight off the vaccine, and then stores away the info in case they come in contact with the disease in the future. It's a powerful tool, but it's not like flipping a switch.

Vaccines don't guarantee immediate and lifelong immunity for everyone who gets them, and the same is true for wild infection of a disease.

If the body isn’t exposed to the pathogen or vaccine again for a long time, the body can “forget” how to make the antibodies, and isn’t as able to adequately fight off an infection—even though the person was vaccinated. “Booster” shots can help keep the immune system primed and ready in case you come into contact with a wild form of the disease, but who and how often you need another dose of vaccine can vary.

While some vaccines provide seemingly lifelong immunity, others' protection fades over time, and—as is the case with the measles vaccine—not everyone is going to get a strong immune response. That means a certainly proportion of a given population will be vulnerable, even if vaccination rates are high.

It's important to note that while vaccines aren't perfect, they are still the best way to prevent diseases like mumps and pertussis.

Drug Resistance

Antibiotics used to be a magic bullet to cure a wide range of diseases. The discovery of penicillin in the late 1920s was a game-changer for mankind, as diseases that used to mean certain death suddenly became treatable. But just as humans have found ways to stave off disease, viruses and bacteria have been adapting, too.

Tuberculosis, for example, used to kill roughly one out of every seven people who got it. Effective diagnosis and treatment have led to a drop in incidence rates in the United States and globally, but that progress is threatened as drug-resistant tuberculosis continues to crop up around the world. In some instances, the bacteria appear to be incurable with existing programs and medications.

Climate Change

Perhaps the largest resurgence of disease is yet to come. With the rise in global temperatures, the earth is seeing changes in not only the environment, but also shifts in animal habitats and human interaction as extreme weather events—always a threat to human health and safety—become more frequent.

Flickers of that are already starting to appear. Dengue fever incidence has increased significantly in the past several decades, in part because of warmer temperatures and higher precipitation allowing its vector, the Aedes mosquito, to expand its habit. Reported cases of waterborne diarrheal diseases commonly seen following heavy precipitation—like legionella and cryptosporidium—have seen a rise in recent years, and warmer waters have made cholera-causing bacteria able to survive in areas they couldn't before. These increases might be only the beginning.

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