The root cause of the increase of immunizable diseases in the United States is
public complacency. After one or more generations of a successful
immunization program, the targeted disease becomes rare and no longer
frightening. Once the public is no longer concerned about a disease, the
financial and political support for disease control measures such as mass
immunizations disappears. This creates cohorts of susceptible adults who were
neither immunized nor exposed as children, a dangerous situation for
employers because many childhood diseases are much more serious in adults.
For example, before mumps immunizations, epidemics of mumps would pass
through a community regularly, and most of the susceptible population would
become immune through having the disease. Complications in these
susceptible children were rare, and most children had the disease before
reaching puberty. Now, through vaccine failure, lack of exposure to disease or
vaccine, and waning immunity, workplace epidemics of mumps can occur.
These adult epidemics are dangerous because adults are prone to severe
sequelae, with attendant high workers’ compensation costs.
Controlling communicable diseases is complicated by the rise of drug resistance
secondary to the misuse of antibiotics. Overprescription by physicians, sharing
prescriptions by patients, the use of massive amounts of antibiotics in animal
husbandry, and the absence of international controls on antibiotics leads to the
evolution of antibiotic-resistant strains of common diseases. Tuberculosis is the
best example of the problem. The tuberculosis bacillus is hard to kill and prone
to developing drug resistance. The repeated exposure of tuberculosis carriers
to ineffective doses of antitubercular drugs dramatically increases the
incidence of drug- resistant tuberculosis. There are only a few effective
antitubercular drugs. These are all prescription drugs in the United States, but
some are available in over-the- counter cough syrup in Mexico.