History Is Destined To Repeat Itself With More Measles Outbreaks
What Have We Learned From Last Year’s Measles Outbreak?
Last year the United States experienced a large, multi-state measles outbreak that was largely responsible for 189 measles cases that spread across 24 states and the District of Columbia. It’s believed that the outbreak started from a traveler who contracted measles overseas and then visited the Disneyland amusement park in California while infectious. Widespread media coverage of the outbreak helped elevate public concerns related to the dangers of measles infection, the consequences of a growing number of school vaccine exemptions and the risks of disease among those who were too young or medically unable to be vaccinated.
At this time last year, it seemed as though we were experiencing a tipping point; a growing number of people were beginning to realize that vaccine refusal had consequences that could threaten our nation’s public health. The fact that the personal decisions of a select few people was able to threaten herd immunity and the health of many unsuspecting families and communities was worrisome.
It was believed that more parents (including some who had previously refused vaccines) were seeking and accepting vaccination for their children as a direct result of the outbreak. However, to determine whether clinicians were experiencing any real or lasting changes in vaccine acceptance, Medscape conducted a survey of vaccine providers to find out.
The survey, conducted in July of 2015, included 1577 physicians, nurse practitioners and physician assistants who worked in pediatrics, family medicine and public health. Responses confirmed that the measles outbreaks induced more acceptance of the measles vaccine and vaccines in general. The survey also indicated that, for some parents, a greater acceptance of vaccines was directly related to the fear of the disease, the consequence of being denied admission to schools, daycares or camps, and a greater knowledge about vaccines as a result of more reading on the subject. However, in some cases there was no change.
Every Child By Two also experienced a heightened amount of interest in the months during and immediately following the outbreak with a record number of inquiries from parents. Most were asking for information about the dangers of measles infection and for clarification of the MMR (measles, mumps and rubella) vaccine schedule. There were many parents who were specifically inquiring as to the possiblity of vaccinating their children before the recommended age in order to protect them during the outbreak. Shot of Prevention blog posts that included content specific to measles infection and MMR vaccination had record numbers of views in the early months of 2015, and personal stories relating to the outbreak, were widely shared on social media.
One story that drew a lot of attention was an open letter by Dr. Tim Jacks, whose two children had to be quarantined after they were both exposed to measles at a Phoenix Children’s Hospital clinic. His 3-year-old daughter Maggie had a compromised immune system as a result of fighting acute lymphoblastic leukemia (blood cancer), while his 10 month old son Eli had received all his recommended vaccines, but was still too young for his first dose of MMR vaccine. While neither of his children ended up contracting measles, the frustration he expressed in his letter entitled “To the parent of the unvaccinated child who exposed my family to measles” hit a nerve with a lot of people.
The Focus of Immunization Rates Fades as Cases Dwindle
In reaching out to Dr. Jacks this week, it appears that the attention on vaccinations that was raised during last year’s outbreak appears to have been rather short-lived. He explained,
“As a pediatrician, I regularly discuss vaccines, exemptions, and last year’s outbreak. The cold facts and data only reach so many, so my family’s story adds a personal angle to the issue that questioning parents rarely consider. After the media exposure, many families were aware of our situation. However today, the measles issue is not on as many people’s minds. Vaccine exemption is however a hot issue in Arizona. The Arizona political arena is considering avenues to encourage vaccination and I am hopeful that the coming year will produce progress in that regard.”
Today, a little over a year since the outbreaks began, the good news is that there have only been two reported measles cases so far in 2016. However, it also appears that history may be destined to repeat itself.
Consider, for example, the reports out just this week about a California charter school student who tested positive for measles after returning home from traveling overseas. With just 43% of kindergarteners at the Yuba River Charter School being up-to-date on their MMR vaccine, the California Department of Public Health has attempted to prevent a measles outbreak by first closing the school to all students, and then remaining closed to those without a measles vaccine until April 8 as long as no new cases are documented.
Despite overwhelmingly high vaccination rates across the country, with a mere 1.7% national vaccine exemption rate among kindergartener’s for the 2014-2015 school year, and a 90%+ coverage of MMR vaccine among 19-35 month old children, these small pockets of unvaccinated children continue to present a risk of future measles outbreaks.
Since measles is a highly contagious virus that lives in the nose and throat mucus of an infected person, it is easily spread to others through coughing and sneezing. It can even linger in the air for up to two hours where it is believed to infect 90% of people who are not already immune to the disease. With more than half of the student population at risk of measles due to lack of immunizations at the Yuba River Charter School, keeping unvaccinated students and staff home is the best way to prevent an outbreak for a disease that requires a 95% vaccination rate in order to create an effective herd immunity.
So, how can we expect to prevent future outbreaks?
While measles cases are likely to continue, there are specific actions we can take to help reduce the risk of outbreaks in our communities. Consider the following:
Understand the “State of the ImmUnion”
Every Child By Two is committed to helping the public understand the importance of immunizations by focusing on the dangers of vaccine preventable diseases. Studies show this is one of the best ways to encourage vaccination and so we have recently kicked off our “State of the ImmUnion” series. Each month, beginning with measles in March and continuing for the remainder of the year, we will focus on the risks of a different vaccine preventable disease.
By sharing our content from our Vaccinate Your Family Facebook Page, Vaccinate Your Family website, @ShotofPrev Twitter account and Shot of Prevention blog, you can help get the facts out about the real risks of disease.
Continue to Refute Vaccine Myths
Unfortunately, while last year’s outbreak focused on the dangers of non-vaccinators, it also served to fuel their efforts to ban together in opposition to state legislation governing vaccine exemptions. As the Medscape survey suggested, the Internet and social media have played a huge role in enabling the growth of the anti-vaccine movement. It is believed that it is easier for parents to discover vaccine myths and anti-vaccine messages online than it is for them to find evidence-based vaccine information.
But it’s also possible for the collective voice of vaccine supporters to make an impact through social media. Just last week, countless scientists, public health professionals, science bloggers and grassroots vaccine advocates took to social media to express their concerns over a film that was produced to advance inaccurate claims about the safety of the MMR vaccine. As mainstream media further exposed the concern over the inclusion of this film at the Tribeca Film Festival, the vaccine conversation was elevated once again. This time, evidence-based information prevailed and the film has since been excluded from the festival.
But certainly, this issue is far from over. Negative publicity is still publicity after all, and this producer is already believed to have secured another venue for the film to be viewed. So while this film, and others like it, will continue to perpetuate dangerous vaccine myths, we must continue to refute the myths and expose this type of misinformation on as many platforms as possible. The goal is to collectively elevate the vaccine conversation among immunization supporters to help provide evidence-based information that supports timely immunizations for people of all ages to those who may be hesitant to vaccinate.
Work to Reduce Pockets of Unvaccinated Children
As mentioned before, even though overall immunization rates are high, threats of outbreaks are often the result of small pockets of unvaccinated children that cluster together in schools like the Yuba River Charter School.
While some states have taken action to prevent disease outbreaks by enacting legislation that works to reduce the number of non-medical exemptions in their state, legislators in other states are still not convinced this is necessary or supported by their constituents. Vaccine supporters must contact their state legislators and express their concern about the number of non-medical vaccine exemptions in their state that can be dangerous to those who are too young to be vaccinated or who are medically unable to be vaccinated. These individuals don’t have a choice and they rely on herd immunity and strong public health policies to keep them healthy.
Stay informed by visiting the following sites:
- Direct links to state immunization websites (http://www.immunize.org/states/).
- State mandates on immunization and vaccine-preventable diseases (http://www.immunize.org/laws/).
- A comprehensive database of state level vaccine facts and policies (http://www.vaccinefactsandpolicy.org).
- Provides a listing of school vaccine requirements and exemptions by state (http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx).
- A new and growing website that parent-volunteers are building to help those who wish to speak up for sensible science-based public health policy (http://vaxadvocacy.org).