Vaccine fears fuelling an avoidable outbreak
MINNEAPOLIS The young mother started getting advice early on from friends in the closeknit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella – it causes autism, they said.
Suaado Salah listened. And this year, her 3-year-old son and 18-month-old daughter contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter was hospitalised for four nights and needed intravenous fluids and oxygen.
‘‘I thought, ‘I’m in America. I thought I’m in a safe place and my kids will never get sick in that disease’,’’ says Salah, 26, who has lived in Minnesota for more than a decade.
Growing up in Somalia, she’d had measles as a child. A sister died of the disease at age 3.
Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organised by anti-vaccine groups, which repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents.
Immunisation rates plummeted and, last month, the first cases of measles appeared. Soon, there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world, which has gained traction in part by targeting specific communities.
Anti-vaccine advocates have defended their position and their role, saying they merely provided information to parents.
‘‘The Somalis had decided themselves that they were particularly concerned,’’ Wakefield said last week. ‘‘I was responding to that.’’
He maintains that he bears no fault for what is now happening within the community. ‘‘I don’t feel responsible at all.’’
Wakefield, a British activist who now lives in Texas, visited Minneapolis at least three times in 2010 and 2011 to meet privately with Somali parents of autistic children, according to local antivaccine advocates.
His prominence stems from a 1998 study he authored, which claimed to show a link between the MMRvaccine and autism. The study was later identified as fraudulent and was retracted by the medical journal that published it, and Wakefield’s medical licence was revoked.
The current outbreak was identified in early April. As of Friday, there were 41 cases, all but two occurring in people who were not vaccinated, and all but one in children 10 and younger. Nearly all have been from the Somali-American community in Hennepin County.
A fourth of the patients have been hospitalised. Because of the dangerously low vaccination rates and the disease’s extreme infectiousness, more cases are expected in the weeks ahead.
Measles, which remains endemic in many parts of the world, was eliminated in the US at the start of this century. It reappeared several years ago as more people – many wealthier, more educated and white – began refusing to vaccinate their children or delaying the shots.
The ramifications have been significant. A 2014-15 measles outbreak infected 147 people in seven states and spread to Mexico and Canada. In California, high school students were sent home because of infected classmates. One patient who was unknowingly infectious visited a hospital and exposed dozens of pregnant women and babies, including those in the neonatal intensive care unit. Another adult patient was hospitalised and on a breathing machine for three weeks.
Minnesota’s Somali community is the largest in the US. The roots of the outbreak there date to 2008, when parents raised concerns that their children were disproportionately affected by autism spectrum disorder.
A limited survey by the state’s health department the following year found an unexpectedly high number of Somali children in a preschool autism programme. But a University of Minnesota study found that Somali children were only about as likely as white children to be identified with autism, although they were more likely to have intellectual disabilities.
Around that time, healthcare providers began receiving reports of parents refusing the MMR vaccine. Activists from anti-vaccine groups started showing up at community health meetings and distributing pamphlets, says Lynn Bahta, a longtime state health department nurse who has worked with Somali nurses to counter MMR vaccine resistance within the community.
At one 2011 gathering featuring Wakefield, Bahta recalls, an armed guard barred her, other public health officials and reporters from attending.
Fear of autism runs so deep in the Somali community that parents whose children have recently come down with measles insist that the disease is preferable to risking autism.
One father, who did not want his family identified, sat helplessly by his daughter’s bed at Children’s Minnesota hospital last week as she struggled to breathe during coughing fits.
The 23-month-old was on an IV for fluids, and had repeatedly pulled out the oxygen tube in her nose. Her older brother, almost 4, endured a milder bout. Neither had received the MMR vaccine.
The children now have antibodies to protect against measles, but they still need the vaccine to prevent mumps and rubella. Their father wants to wait, however. His worry: autism. A colleague has a son who is mute, he says. ‘‘I would hold off until she’s 3 . . . or until she fluently starts talking.’’
His wife no longer harbours doubts, however. As soon as both WASHINGTON POST children are well, she says, ‘‘they are going to get the shot’’.
While scores of studies from around the world have shown conclusively that vaccines do not cause autism, that is often not a satisfactory answer for SomaliAmerican parents. They say that if science can explain that vaccines don’t cause autism, science should be able to say what does.
But researchers don’t really know. A growing body of evidence suggests that brain differences associated with autism may be found early in infancy – well before children receive most vaccines. Other studies have found that alterations in brain cell development related to autism may occur before birth. There are some genetic risk factors for autism, and advanced parental age has been associated with the condition.
Meanwhile, the ongoing spread of the anti-vaccine message is making it harder to control the burgeoning number of measles cases.
When their two sick children are well, Salah and her husband, Tahlil Wehlie, plan to talk to friends and acquaintances to spread the word that the antivaccine groups are wrong and that all youngsters should get immunised. But she understands the apprehension that fed the outbreak. With a parent whose child has autism, ‘‘it’s something that you’re looking for an answer for how it happened’’. Washington Post