Last Friday, the governor of Washington declared a public health emergency for that state because of an outbreak of an extremely contagious and potentially life-threatening disease. The reason for the outbreak is entirely predictable, reports the AP:
The number of confirmed measles cases near Portland grew to 31 on Friday — an outbreak boosted by lower-than-normal vaccination rates in what has been called an anti-vaccination U.S. “hot spot.”
Public health officials in southwest Washington, just across the Columbia River from Portland, Oregon, said people may have been exposed to the dangerous disease at more than three dozen locations, including Portland International Airport, a Portland Trail Blazers game, an Amazon Locker location and stores such as Costco and Ikea.
Twenty-six of the confirmed patients had not been vaccinated against measles, and the vaccination status of four others who were infected is unknown. One child has been hospitalized. Authorities say nine additional cases are suspected.
We’ve explored the history of measles before, including in this 2014 PediaBlog post:
The paramyxovirus that causes measles is a highly infectious respiratory virus. Also known as rubeola — not to be confused with rubella (German measles) and roseola — measles causes symptoms of fever, runny nose (coryza), cough, and conjunctivitis (medical students learn about these “3 C’s” of measles), followed by the classic, diffuse morbilliform (measles-like) rash. Severe and potentially fatal complications include pneumonia and encephalitis. Before measles vaccine was introduced in 1963, nearly all children in the U.S. developed measles before the age of 15; 40,000 people per year were hospitalized; 7,000 had seizures; 1,000 suffered permanent brain damage or hearing loss; and 500 died. Worldwide, measles is still a scourge, infecting 20 million people each year and killing 164,000 (more than half in India).
Because immunization rates in most areas of the U.S. have been historically high over the last several decades, cases of measles are rare. So rare, in fact, that the Centers for Disease Control and Prevention declared measles eliminated from the United States in 2000. In 2016, we celebrated the World Health Organization’s announcement that measles had been eradicated from the Americas (North, Central, South, and the Caribbean). However, it now seems that those announcements may have been premature. Indeed, there have been several outbreaks of measles in the U.S. over the last several years. Last year, the CDC reported 17 separate outbreaks of measles involving 349 individual cases, spread over 26 states and the District of Columbia. In 2015, an outbreak that appeared to begin at California’s Disneyland infected 147 people, mostly children, over several states. 2014 saw the largest number of annual cases (667) from 23 outbreaks reported to the CDC in this century. The CDC points to two reasons why we still see measles outbreaks in this country:
In a given year, more measles cases can occur for any of the following reasons:
- an increase in the number of travelers who get measles abroad and bring it into the U.S., and/or
- further spread of measles in U.S. communities with pockets of unvaccinated people.
In Clark County, Washington, public health officials are scrambling to contain the outbreak which originated in a county where many parents choose not to vaccinate their children. Now the children who are sick and ordinary taxpayers will pay the price:
Clark County has already spent more than $100,000 trying to contain the outbreak, and staff is being pulled from other duties, including restaurant inspections, he said.
“It’s all hands on deck. Clearly this is going to cost hundreds of thousands of dollars, and it wouldn’t surprise me if we were in the seven figures by the time we’re done here,” he said. “These costs could have been prevented if we had everybody vaccinated.”
Clark County, which includes the Portland bedroom community of Vancouver, Washington, has a measles vaccination rate of 78 percent, well below the 92 to 94 percent rate required for so-called “herd immunity,” said Marissa Armstrong, the department’s spokeswoman. Herd immunity happens when unvaccinated individuals are protected from infection because almost everyone around them has been vaccinated and is immune to a disease.
The current measles situation in Washington exemplifies why modern societies in developed countries vaccinate their children (and why parents in developing countries are envious of our capabilities to prevent common and deadly vaccine-preventable diseases). The MMR vaccine works (93% effective after the first dose; 97% effective after the second), is safe (it does not cause autism), is covered by every insurance carrier and is free for children without health insurance coverage. And it saves lives!
The threats to children’s health and the costs to society caused by the failure of parents to vaccinate their children go far beyond the confines of their own homes and communities. As we will see tomorrow, vaccine hesitancy is a global public health threat.