I don’t know whether you all remember my last few sentences of last week’s post but I was so encouraged this week because it seems that maybe some of the politicians are reading my blog (yeah right!?!?) or they recognize the severity of the measles problem today. So, I want to continue the discussion starting with a number of States who get the message.
Patti Neighmond wrote that all U.S. states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, to be able to attend school. Such laws often apply to children in private schools and day care facilities as well as public schools.
At the same time, beyond medical exemptions, most states also allow parents to opt out of this vaccination requirement for religious reasons. And 17 states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons.
Michelle Mello, a professor of law and health research and policy at Stanford University, says the bar for claiming an exemption from vaccine requirements has been very low in many states. “You can believe that vaccines don’t work or that they are unsafe or they simply fly in the face of your parenting philosophy,” she says.
But this winter’s outbreaks of measles across the nation are resulting in challenges to many exemptions: At least eight states, including some that have experienced measles outbreaks this year, want to remove personal exemptions for the measles vaccine. And some states would remove the exemption for all vaccines.
Most of this year’s measles cases have been among children who were not vaccinated against the virus.
Once considered eradicated in the U.S., measles has sickened at least 159 people since the start of 2019, according to the Centers for Disease Control and Prevention, in outbreaks ranging from Washington and Oregon to Texas and New York. Last year, there were 372 reported cases of measles nationwide.
The move among state legislatures to tighten vaccine requirements is good news to Diane Peterson, the associate director for immunization projects with the pro-vaccine advocacy group Immunization Action Coalition.
“Measles is not like a common cold,” Peterson says. “Children get very, very sick and can be hospitalized,” she says, adding that measles can even lead to death.
The virus is highly contagious, airborne and easily spreads. It can survive in the air for a couple of hours.
“A patient with measles can go to the doctor, cough in the exam room and two hours later another patient coming into the same exam room can be infected,” Peterson says.
The virus is spreading fast this winter, she says, because of the “pockets of children who have not been vaccinated, mostly due to parents who have decided not to vaccinate them.”
This leaves not only those unvaccinated school children vulnerable to the virus but also many adults who have suppressed immune systems and infants who are not old enough to be vaccinated.
According to the Association of State and Territorial Health Officials, bills to restrict exemptions are now pending in a growing number of states.
None of this sits well with activists who want their states to maintain personal and philosophical exemptions.
“Nobody should sit in judgment of another person’s religious and spiritual beliefs,” says Barbara Loe Fisher, a spokesperson for the National Vaccine Information Center, a group that lobbies against mandatory vaccination and thinks parents should have a choice. “No person should be allowed to force someone to violate their conscience when they’re making a decision about the use of a pharmacological product that carries a risk of harm.”
The scientific consensus about any risk from vaccines is that serious side effects are extremely rare. A suggestion that immunization might be tied to severe consequences like autism was debunked years ago after findings supporting that link were proved fraudulent.
Mello, the Stanford law professor who has been following the exemption debate, notes that the courts have repeatedly held that when a public health intervention is necessary to safeguard the public, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school.
So far, only three states — Mississippi, West Virginia and California — prohibit nearly all vaccine exemptions, including the one exempting families who say their religious belief conflicts with vaccination. (All states allow medical exemptions when, for example, a child has a compromised immune system.)
The California state Legislature made that decision in 2015, less than a year after the state experienced a significant measles outbreak that got its first foothold among unvaccinated children visiting Disneyland.
A measles outbreak in the US has triggered debate on the ease with which parents can opt out of mandatory vaccine rules.
I noted last week that a total of 159 people have come down with the disease in 10 states since January, but one small area, in particular, Clark County in Washington State, has illustrated the dangers of these exemptions, which are sought for religious, personal or philosophical reasons.
Just north of Portland, Oregon, Clark County accounts for 65 measles cases, 47 of them among children under age 10. In almost all 65 cases, patients had not been vaccinated.
Fifteen years ago, 96 percent of school children aged five in Clark County got measles shots. But in 2017-2018, the proportion was down to 84 percent.
In some schools, mainly private ones, the rate of use of the so-called MMR vaccination against measles, mumps, and rubella was only 20 to 30 percent. In some of the schools, more than half the students had received exemptions.
Local lawmakers in Washington State have responded to the outbreak by advancing legislation that would do away with exemptions on personal or philosophical grounds. Opt-outs for religious reasons would still be allowed.
Such exemptions are widely available in the United States. Only three of the 50 states—California, Mississippi, and Virginia do not allow them.
California did away with exemptions for personal reasons in 2015. In the most populous US state, exemptions are permitted only for medical reasons.
In recent years other states have toughened their laws. Connecticut, for instance, requires parents claiming an exemption for religious reasons to provide a yearly, notarized statement to this effect. Since 2015, Delaware has allowed schools to temporarily exclude non-vaccinated kids.
Vermont wants to get rid of religious exemptions, after eliminating those sought for philosophical reasons four years ago, according to The Washington Post. Arizona, Iowa, Minnesota are also debating stricter laws.
The US Congress will hold a hearing Wednesday on the issue of vaccinating children.
Overall, the vaccination rate of kids in the US has remained stable, according to the Centers for Disease Control and Prevention, which monitors such trends closely.
It reports that in the 2017-2018 school year, around 95% of American kindergarteners were vaccinated against MMR, chicken pox and diphtheria, tetanus and whooping cough.
But the national rate masks wide disparities from state to state and even from one school to the next, as the case of Clark County illustrates.
And health authorities are alarmed because the previous school year was the third in a row in which requests for exemptions from vaccination increased, even though the rises were small.
And the proportion of kids reaching age two without having received any kind of vaccination is also growing, albeit slowly: 0.9 percent of children born in 2011 to 1.3 percent among those born in 2015. Vaccination-free kids were practically unheard of at the turn of the century.
Exemptions alone do not explain why children are not vaccinated. Many vaccines are recommended for American children in their first two years of life—the CDC advises they be used for 14 diseases—and this is hard for parents to keep up with, especially for vaccines that require three or four shots.
Another problem is access to health insurance. Children in families without such insurance make up a disproportionate amount of those who go without shots, according to the CDC.
In Congress, the measles outbreak has prompted lawmakers to act.
The disease routinely infected American kids before a vaccine was introduced in 1963. Before that, it killed 400 to 500 people a year in the US. In 2000 it was declared eliminated. But since then, over the years anywhere from 50 to 600 cases have been reported annually.
Two US senators recently called on the CDC to explain what it is doing in response to what they called “pockets of unvaccinated people.”
‘We Need to Get to Zero’ on Measles: NIAID Chief to House Panel
I think we all agree and members from both parties express support for measles, mumps, and rubella vaccine
Our friend Joyce Frieden, the News Editor of MedPage Today, reported that the views that some House committee members expressed Wednesday in favor of vaccination brought to mind a line from a character on a British television show: “I am unanimous in this.”
“It wasn’t until the development of the MMR [measles, mumps, and rubella] vaccine that we as a country were able to stop this horrific illness,” said Rep. Diana DeGette (D-Colo.), chairman of the House Energy & Commerce Subcommittee on Oversight and Investigations, at a hearing on recent measles outbreaks in the U.S. “But despite that success, here we are again 20 years later.”
Rep. Greg Walden (R-Ore.), a ranking member of the full Energy & Commerce Committee, noted that one in four people diagnosed with measles will end up being hospitalized. “If we don’t reverse the downward trend in vaccination, we risk bringing back measles in full force,” he said.
DeGette called the recent measles outbreaks “a real cause for national concern” and pointed out that the national measles vaccination rate for children stands at 91%.
“That may seem high to some, but it’s well below the 95% vaccination rate required to protect communities and give them herd immunity,” she said. “And while the overall national rate of MMR vaccines is currently at 91%, the rate in some communities is much lower — some as low as 77%. Outbreaks like the one we’re seeing with measles remind us of just how interconnected our communities are … As a nation, to stop the spread of deadly diseases, we have to address the root cause of the problem and we have to define concrete steps … We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines.”
Nearly 160 Cases This Year
Once again the numbers are important and so from Jan. 1, 2019 to Feb. 21, 2019, there have been 159 confirmed measles cases in 10 states, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told the committee. The states reporting outbreaks include California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people in 25 states and the District of Columbia were reported to have measles; most of those cases involved unvaccinated people, she added.
Although measles was officially eliminated in the U.S. in 2000, and the rate of measles vaccination coverage is fairly high nation-wide, “there are pockets of people who are vaccine hesitant who delay or even refuse to vaccinate themselves and their children,” which can cause outbreaks, Messonnier said. Many of those live in close-knit communities where they share the same religious beliefs or ethnic backgrounds as their neighbors. Others simply have a strong personal belief against vaccination.
“In the past 5 years, there have been 26 measles outbreaks of more than five cases, 12 of which were in close-knit communities, including a Somali community in Minnesota in 2017 and Orthodox Jewish communities in New York City and New York state in 2018; these 12 outbreaks account for over 75% of cases in the past 5 years,” she said, adding that “Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy vary by community” and must be attacked locally with the help of the CDC.
The federal government’s Vaccines for Children (VFC) program is a “critical component” of the fight against vaccine-preventable diseases, Messonnier said. “Because of VFC, we have seen significant decreases in disparities in vaccination coverage … For each dollar invested [in the program], there are $10 of societal savings and $3 in direct medical savings.”
‘I Am a Measles Survivor’
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, said that measles was “one of the most contagious pathogens we know of” and explained that since the virus has been well sequenced, “we can tell, when the virus is reintroduced into our country, from where it comes.” For example, researchers were able to determine that a measles virus that led to an outbreak among a community of Hasidic Jews in Brooklyn in New York City came from Israel.
“I consider it really an irony that you have one of the most contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we don’t do and have not done what could be done — namely, completely eliminate and eradicate this virus.” Fauci showed a slide delineating the recent outbreaks. “This slide is really unacceptable; this is a totally vaccine-preventable disease … What we all should strive for, that measles in the United States, we need to get to zero.”
A few hearing participants shared their own experience with the disease. “I am a measles survivor,” said Rep. Michael Burgess, MD (R-Texas). “I was at an age where the measles vaccine was not available. Even though I was very young when that happened, I still remember … the heart-shaking chills, the muscle pain, and the rash that’s [emblematic] of measles.” Fauci said he also had the disease and that it was “very uncomfortable and very scary.” Rep. Brett Guthrie (R-Ky.), the subcommittee’s ranking member said that one of his close childhood friends “was essentially born without a hand” after the friend’s mother contracted rubella during her pregnancy. “I’ve always thought of measles and how devastating it can be.”
Guthrie also asked Fauci whether people could “self-medicate” with vitamin A to prevent measles. Fauci responded that children with vitamin A deficiency who get measles “have a much more difficult course, so vitamin A [supplements] can actually protect you from some of the toxic and adverse effects,” but that doesn’t apply in developed countries where such deficiencies are rare. “It doesn’t prevent measles, but it’s important in preventing complications in societies in which vitamin A deficiency might exist,” he said.
The Thimerosal Question
Burgess asked about whether thimerosal — a mercury-containing preservative often mistakenly claimed to cause problems with vaccines — was in the measles vaccine. “No, it’s preservative-free,” said Fauci. Burgess asked whether there was ever any evidence that mercury or thimerosal was unsafe. Messonnier said thimerosal had been removed from vaccines “out of an abundance of caution at a time when there wasn’t enough evidence, but evidence since then has been very conclusive” that thimerosal is safe.
The hearing was also marked by a few disruptions, including some shouts from the audience when Fauci, responding to a question, said that the measles vaccine couldn’t cause encephalitis. DeGette told the audience that such disruptions were in violation of House rules; Messonnier then said that the vaccine doesn’t cause brain swelling or encephalitis in healthy children.
Guthrie remarked that whether or not parents choose to vaccinate their children, they do so with the best of intentions. “Whatever decisions they’re making, they’re making it in the love and best interest of their child,” he said. “So I think it’s important we do have the science … and people with credentials and reputations to present this evidence, and hopefully people have the opportunity to see it and read it.”
Measles cases soar worldwide, UN warns of ‘complacency’
Outside of the U.S., I think it is necessary to see how this disease is affecting other countries. I brought up the statistics regarding the incidence and the deaths in the Philippines but on a broader scale Cynthia Goldsmith reviewed the statistics with regard of the measles problem in the world and noted that just 10 countries were responsible for three-quarters of a global surge in measles cases last year, the UN children’s agency said Friday, including one of the world’s richest nations, France.
Ninety-eight countries reported more cases of measles in 2018 compared with 2017, and the world body warned that conflict, complacency and the growing anti-vaccine movement threatened to undo decades of work to tame the disease.
“This is a wakeup call. We have a safe, effective and inexpensive vaccine against a highly contagious disease—a vaccine that saved almost a million lives every year over the last two decades,” said Henrietta Fore, executive director of UNICEF.
“These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”
Measles is more contagious than tuberculosis or Ebola, yet it is eminently preventable with a vaccine that costs pennies.
But the World Health Organization last year said cases worldwide had soared nearly 50 percent in 2018, killing around 136,000 people.
Ukraine, the Philippines, and Brazil saw the largest year-on-year increases. In Ukraine alone, there were 35,120 cases—nearly 30,000 more than in 2017.
Brazil saw 10,262 cases in 2018 after having none at all the year before, while the Philippines reported 15,599 cases last year compared to 2,407 in 2017.
Taken together, the ten nations accounting for 75 percent of the increase from 2017 to 2018 account for only a tenth of the global population.
The countries with the highest rate of measles last year were Ukraine (822 cases per million people), Serbia (618), Albania (481), Liberia (412), Georgia (398), Yemen 328), Montenegro (323) and Greece (227).
While most of the countries that experienced large spikes in cases are beset by unrest or conflict, France saw its caseload jump by 2,269.
In the United States, there was a 559 percent year-on-year increase in cases from 120 to 791.
Misinformation and mistrust
The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement.
The WHO last month listed “vaccine hesitancy” among the top 10 most pressing global health threats for 2019.
“Almost all of these cases are preventable and yet children are getting infected even in places where there is simply no excuse,” Fore said.
“Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency.”
In war-torn Yemen, where health services in many regions have collapsed, UNICEF and the World Health Organization joined with local authorities last month in a campaign to vaccinate some 13 children aged six months to 15 for measles and rubella.
UN officials estimated that 92 percent of the targeted children were jabbed during the one-week push, which ended on February 14.
Yemen also figured on UNICEF’s “top 10” list of countries showing the largest increases last year in measles cases with a 316 percent hike, from 2,101 cases in 2017 to 8,742 cases in 2018.
Other countries with huge jumps last year compared to 2017 are Venezuela (4,916 more cases, up 676 percent), Serbia (4,355 more cases, up 620 percent), Madagascar (4,307 more cases, up 5,127 percent), Sudan (3,496 more cases, up 526 percent) and Thailand (2,758 more cases, up 136 percent).
A few countries saw declines in the number of confirmed cases of measles.
In Romania, reported cases dropped 89 percent from 8,673 to 943, and in Indonesia, the number declined by 65 percent from 11,389 to 3,995.
Nigeria, Pakistan, Italy, and China also saw drops of 35 to 55 percent.
So, the number of worldwide resurgence of cases of measles is huge and we as a community need to step up and push our healthcare community and the government to step up and demand that we protect our youth both here in the U.S.A. and yes, in the world. Also, we need to ignore the politics and the misinformation and mistrust and get the job done for our kids, and future generations!