Vaccine Skeptics on the Rise
Latest Measles Outbreak Shines Light on Trend Worrying Health Officials
By Betsy McKay and Jeanne Whalen in the Wall Street Journal
The measles outbreak that began at California’s Disneyland Resort last month is part of a new trend that worries public health officials.
Large outbreaks in the U.S. of the highly infectious disease have become more common in the past two years, even though measles hasn’t been indigenous since 2000, according to the Centers for Disease Control and Prevention.
At the same time, persuading skeptical parents to vaccinate their children has grown more difficult because concerns about a possible link between vaccines and autism—now debunked by science—have expanded to more general, and equally groundless, worries about the effects of multiple shots on a child’s immune system, vaccine experts and doctors say.
While vaccination rates across the nation have been high since the mid-1990s—at 94.7% for the measles, mumps and rubella vaccine for kindergartners in the 2013-14 school year—some communities and groups in pockets of the country eschew or delay vaccinations, and the number of susceptible people in such communities is growing, said Gregory Wallace, who heads the CDC’s domestic measles, mumps, rubella and polio team.
That’s because with measles no longer circulating regularly in the U.S., far fewer people have immunity from getting the disease itself, he said. “The amount of people will grow if you’re not vaccinating and you don’t get the disease,” he said. As a result, he said, “We’re seeing young adults in these outbreaks.”
The larger outbreaks have officials and experts concerned that measles could make a comeback in the U.S. “The concern clearly is the potential for a much bigger resurgence,” said Walter Orenstein, professor of medicine, pediatrics and global health at Emory University and associate director of the Emory Vaccine Center. “We’ve got to overcome the hesitancy issue.”
“In the past, when there was much higher measles incidence, susceptibility by the teenage years was pretty low,” he said. “Either you got vaccinated or you got the measles.”
Measles is a highly contagious respiratory disease causing fever, cough and rash. It can lead to pneumonia and encephalitis and in about 1 in 1,000 cases, death. Young children are at particular risk of complications. In the U.S., 0.2% to 0.3% of people who become infected die from measles complications, according to Dr. Orenstein. Globally, in 2013, an estimated 145,700 children died from measles, according to the CDC. Measles deaths have declined sharply over the past several years due to vaccination.
Measles doesn’t spread in most U.S. communities because people are protected by “herd immunity,” meaning that 92% to 94% of the population is vaccinated or immune. That level of protection makes it hard for one case of measles to spread even from one unvaccinated person to another without direct contact.
But outbreaks can erupt when someone who has been infected in another country brings the disease to the U.S. and passes it on to others in communities with high numbers of unvaccinated people. Those communities range from wealthy neighborhoods to clusters of religious and ethnic groups that either forgo or delay vaccinations for children.
Between 2001 and 2011, there were 63 outbreaks of measles in the U.S., but they were small, according to the CDC. In 2013, though, three outbreaks had more than 20 cases, including one in an Orthodox Jewish community in New York with 58 cases.
In 2014, Amish travelers became infected on a church mission to the Philippines, where a large measles outbreak was under way; the disease spread rapidly once they returned to their communities in Ohio. That outbreak helped make 2014 the busiest year for measles in the U.S. since at least 2000, with 644 cases in 27 states. Many of the other cases—including several in California—were also brought or spread by travelers from the Philippines.
The latest outbreak, which started in December, involves at least 77 cases as of Friday in seven states and a child in Mexico, according to the CDC.
The vast majority of cases are in Southern California. In some schools in the San Diego area, 20% to 30% of children are not immunized, said Mark Sawyer, professor of clinical pediatrics at UC San Diego School of Medicine.
Often, these schools are in upper middle class neighborhoods, such as San Diego’s North Coastal community, he said. “It’s because these people are highly educated and they get on the Internet and read things and think they can figure things out better than their physician. That’s a universal phenomenon around the country,” he said. “People who come to the U.S. from other countries are very compliant [with vaccination] because they come from places where measles is still seen.”
Pediatricians and vaccine experts say more needs to be done to identify communities of vaccine skeptics and help doctors serving those areas to educate patients. For the past five years Dr. Sawyer has held seminars in various neighborhoods, including the North Coastal area, to try to persuade parents to vaccinate.
Typically, he brings an autism expert from UCSD to talk about the disease and the lack of a link to the MMR vaccine. But parents’ concerns these days have moved beyond just autism, he said. “It’s morphed into a more generic concern that maybe we’re overwhelming the immune system with all these vaccines, maybe there are other side effects, maybe we don’t need all these vaccines,” he said, calling these fears unfounded. The seminars, he said, are only “moderately attended.”
“Some of these parents have really made up their minds and are not open to it. They’ve just decided it’s not for them,” he said.
Religion is often held up as a reason parents don’t vaccinate. But after the big outbreak in Ohio last year, Amish community elders were receptive to the idea of vaccination, said Robert Frenck, director of infectious disease at Cincinnati Children’s Hospital Medical Center.
“When the Ohio Department of Health went in and talked to their elders, they said we really don’t have an objection to the vaccination. We just didn’t understand it was that important,” Dr. Frenck said.
Dr. Frenck said he first saw measles in 1990 during a medical fellowship in Houston. The disease had been largely stamped out in the U.S. before that time, but some immigrants from Mexico caused an outbreak in the Houston area, he said. “We had to go look for doctors in their 50s and 60s and said, ‘Can you come teach us measles?’ Because we’d never seen it before,” he said.
“Vaccines are their own worst enemies—they’ve been so effective and so good at preventing disease that people forget what the disease looks like,” Dr. Frenck says. “What they’re afraid of is adverse events.”