State Health Department: Measles Vaccination Remains Vital to Protecting Against Highly Contagious Disease ALBANY, N.Y. (September 21, 2012) – In light of confirmation of a measles case in a school…


"Nidus" is a mid 19th century term used by medical geographers used to describe what we today might call potential hot spots for disease.  A nidus is the "nest", where the first cases develop and from there spread to other locations either radially or along specific kinds of routes such as along a waterway, through a valley, by following a particular assemblage of plants and animals.   Medical geographers in the mid-19th century had perfected this way of understanding disease development, to such an extent that they could use such unusual physiographic features as aspect of a hillside and the slope of that location to define where the disease might fester, due to the "animalcules" or microbes that lives there naturally.  (Unlike what common teachings like to profess, bacteria was the first small organism we related to diseases.)


Since the 1980s, there have been at least four outbreaks of measles in the valley, and they share certain common population, travel, and business or economics features.  And they represent a classic example of the hierarchical diffusion process (see my page on this – ).


Three of the articles and discussions of these four cases have one town or village as a common source for the cases.  The case that emerged just a day or so ago is somewhat to the north, associated with the local railways system returning a student to his/her college setting.  The case from two or three years aback also involved schools in some way and local international travel–in that case it was the school that allowed 50% of its students to not be vaccinate, per their personal belief or faith.   The association of the Rhinebeck-Bard-Tivoli cases with those in New Paltz across the river also shared university-international travel or foreign students features.


The fourth location to the south is where the first recent mention of this problem returned to the local newspapers, down by the Palisade Mall in lower New York.


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Now, it is easy and at times too easy to draw these comparisons between regions and see similarities.  Culture itself for example is not the cause for this part of the valley showing a tendency to be a nidus.  Statistically, I might call it a covariate.  The main factor in this migration of measles into the eastern U.S. is the population health behavior features, and the fact that the Hudson valley has  a unique behavioral feature–programs that bring together many people who demonstrate a strong support of personal beliefs, personal rights to chose, and "alternative forms of medical beliefs or thinking."  


We all have the right to be "different".  If only we knew how our differences influence the right of others to live a secure life, without fear of that terrible Scarlet letter coming close to our kids, elders, or family members engaged in critical quality of life related health care.  In this case, cultural diversity works against the continued survival of these different communities.  There are some rules that must be followed by all cultures, no matter what sacrifice of personal rights may be required.


We map physical and human geography all of the time when we research spatial epidemiology.  Small scale area analyses may be used to define specific natural ecosystems or niduses required for west nile to develop in this region (I posted my example of successfully using this technique in 2002 and 2003, a while back).  We can also use small area analyses to identify niches of unhealthy communities or shared communal settings.


One has to wonder, how much of this type of cultural analysis of disease (if any) is engaged in locally? 


In the past few days, a comparable social behavioral pattern has emerged recently in Minnesota as well (  ).


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