CAUSES FOR THE CURRENT 2019 MEASLES OUTBREAK
The United States is in the midst of the largest measles outbreak in a quarter century and it has health officials scrambling to come up with answers to protect the public. Why is a disease that was declared eliminated in the United States 19 years ago become such a wide spread health concern? How much of what we hear or read is fact or false? The answers to these questions may surprise you.
The Centers for Disease Control (CDC) recommends getting 29 doses of 9 vaccines as well as a yearly flu shot after 6 months of age until age six. (R., Ruppert, & Souto, 2019) There are no US federal laws that mandate vaccination, however all 50 states require certain vaccinations for children entering public schools. There are exceptions as most states offer medical and religious exemptions and still others allow philosophical exemptions. (R., Ruppert, & Souto, 2019)
Advocates proclaim that vaccination is safe and point out that illnesses, including rubella, diphtheria, smallpox, polio, and whooping cough, are now averted by vaccination and millions of children lives are saved with reactions to vaccines being very rare. (Manke, 2019)
Opponents point out those children’s immune systems can deal with most infections naturally, and the vaccines injected in children cause side effects, such as seizures, paralysis and death. (Manke, 2019) Some go as far to say that numerous studies prove that vaccines may trigger problems like autism, ADHD, and diabetes. (Manke, 2019) With such conflicting statements being made by both the advocates and the opponents it is no wonder why there are difficult decisions for parents to make when it is time to vaccinate or not.
At the forefront of the media today are reports of a measles outbreak and that measles has serious consequences as it lands 1 in 4 infected people in the hospital, 1 in 1000 will develop encephalitis (swelling of the brain): and kills 1or 2 in 1000. (R., Ruppert, & Souto, 2019) The measles were declared eliminated in United States in the year 2000 due to widespread immunization. In other words enough people were immunized that outbreaks were uncommon, and hearing about death from measles was scarce. However we are in the midst of resurgence due in part to lower immunization rates, led by parents who claim religious and philosophical exemptions to vaccinations. Requests for exemptions are based on unfounded safety concerns, one of which points out that measles, mumps, and rubella (MMR) vaccine causes autism, sparked by such articles like one that appeared in the scientific journal The Lancet in 1998, the journal later retracted the article as numerous studies have debunked such claims. (Manke, 2019) This article seemed to be the first of many that spread false information, but information that many take seriously. The vaccine is known to be extremely safe and very effective; it contains a live but weakened version of the virus, which is designed to cause your immune system to produce antibodies against the virus. (Belluz, 2019) If you are vaccinated and should you be exposed to the actual measles virus, those antibodies will then become active to protect against the disease. (McKay & West Grayce, 2019)
The outbreaks have occurred in a concentration of mostly four states: New York, New Jersey, California and Washington. However as of May 17th the CDC reports 839 individual cases in 23 states. (R., Ruppert, & Souto, 2019) Of the 839 cases reported to date the majority have occurred in Orthodox Jewish communities in New York City and New York suburb of Rockland. (Belluz, 2019) It is in communities like Rockland that a minority of community members who are opponents of vaccination and have been opting out on behalf of their children. What this does is drive vaccine rates down and creates gaps for the highly contagious virus to spread. What typically happens to start the outbreak is a traveler picks up the virus in another country where measles is still common and brings it back to an unvaccinated community. This is likely the reason for the New York outbreak where travelers who had recently traveled to Israel, where a massive measles epidemic is currently underway. (Belluz, 2019) Just as I stated before these travelers return to the United States and spread the virus among unvaccinated or under vaccinated communities. The Washington state outbreak has been narrowed down to “patient zero” who had traveled outside the United States to Eastern Europe and upon return to Washington came in contact with unvaccinated children located in Clark County in SW Washington State. These children then visited public places spreading the highly contagious virus. (McKay & West Grayce, 2019)
What both the Rockland New York and Clark County Washington state outbreaks have in common is they both are occurring in communities with high rates of people who have opted out of vaccines, on behalf of their children. As well in both states the outbreaks occurred amongst tight-knit, traditional communities in New York it is the Orthodox Jewish community and in Clark County Washington it is a concentration of Slavic immigrants. (Belluz, 2019)
According to 2016 CDC data 91% of young children have received the MMR vaccine however that may not be enough for what is known as “herd immunity”; this means that in order for a vaccine to be effective you need to have a certain percentage of people in a population immunized. What this does is to prevent the disease to spread through populations easily, and this protects even those who aren’t or can’t be vaccinated, like newborns and people with vaccine allergies or other health concerns. For measles 90 to 95 percent of the population needs to get the vaccination shots for herd immunity to be effective. (McKay & West Grayce, 2019)
What the statistics are showing is that there are geographic areas of unvaccinated people and these concentrated areas of non-vaccination can be very high. According to a 2018 analysis published in PLOS Medicine, dozens of counties across the country had nonmedical vaccine exemption rates around 30 percent, leading that statistic was Camas County Idaho with 27 percent opt-out rate. (Belluz, 2019)
Skepticism about vaccines has been growing over past years, spread through written material (like the damaging report in The Lancet publication), conference calls, face-face conversations, a dial-in-phone line set up by Jewish women in New York City also contributed according to city officials, the recorded messages spoke about everything from religion to parenting advice to lectures about “the truth about vaccines”, which are described to be in anti-vaccination tone. (McKay & West Grayce, 2019)
Professor and division head of epidemiology at the University Of Berkeley School Of Public Health Art Reingold provided an interview to help set the record straight, one of his statements was “vaccines are not 100 percent risk-free, but they are very, very, very safe, and they do not cause autism.” (Manke, 2019) When asked how effective the MMR vaccine is at preventing measles, he responded, “It depends on the age at which you received the vaccine, but it mostly depends on getting two doses rather than one. One dose of measles vaccine is only 93 percent effective, but two doses are over 99 percent effective, which is why we have a two-dose strategy. The vaccine-induced immunity should be present seven to 10 days after immunization.” (Manke, 2019)
A group called Parents Educating and Advocating for Children’s Health (PEACH) circulated a 40 page document titled “The Vaccine Safety Handbook: An Informed Parent’s Guide,” The document includes anti-vaccination claims with first person stories and Jewish “points of interest.” (McKay & West Grayce, 2019)
The authors of PEACH asked Jennifer Margulis to speak on their behalf as they are afraid of being targeted for being both Jewish and anti-vaccination. This article states that Ms. Margulis is a writer from Ashland, Ore., and describes herself as a children’s health advocate who thinks parents should be able to choose whether they vaccinate their own children. Ms. Margulis says that these parents start to question about the vaccine after a child has a bad reaction to one. (McKay & West Grayce, 2019)
New public health tools are needed, according to Herminia Palacio, New York City’s deputy mayor for Health and Human Services, including an “aggressive counter-messaging campaign to really counteract the very intentional misinformation and disinformation that is being dangerously propagated by a small but well-organized coalition of groups across the country.” (McKay & West Grayce, 2019)
There are efforts underway to create changes in Washington State the Senate passed a bill to limit the vaccine exemptions and in New York City fining people who aren’t vaccinated $1000 has been implemented. (McKay & West Grayce, 2019) One theory that has been talked about is people feel that it is lack of strict legislation that has allowed the measles to return after it was declared eliminated.
In conclusion there is a lot of educating that needs to be done, unfortunately due to misinformation that is still being distributed a mixed message continues to blur parent’s knowledge to make accurate decisions. It only seems fare to acknowledge that it is unethical to endanger others due to your belief that vaccination is harmful, and as we have pointed out this misinformation is a root cause for the lack of doing so. Until more is done to educate the facts we may fall further behind in eliminating measles for the second time in United States history.
Belluz, J. (2019, April 29). 8 Things everybody should Know About Measels . Retrieved May 16, 2019, from Vox: https://www.vox.com/2019/1/29/18201982/measles-outbreak-virus-vaccine-symptoms
Manke, K. (2019, March 10). Expert Calls Vaccine ‘Very, Very, Very Safe’. Retrieved May 17, 2019, from UC Berkeley: https://www.futurity.org/measles-vaccines-viruses-2003552-2/
McKay, B., & West Grayce, M. (2019, May 5th). What Can Stop the Measels Outbreak? Officials Lean on an Unlikely Band of Locals. Retrieved May 16, 2019, from The Wall Stree Journal: https://www.wsj.com/articles/what-can-finally-stop-the-measles-outbreak-officials-lean-on-an-unlikely-band-of-locals-11557077101
R., M., Ruppert, P., & Souto, M. e. (2019, May 17). Notes from the Field: Measles Outbreaks from Imported Cases in Orthodox Jewish Communities-New York and New Jersey 2018-2019. Retrieved May 17, 2019, from Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a4.htm?s_cid=mm6819a4_w