Out­break of measles over; furor is not

Spread that be­gan at Dis­ney­land has ended, but the po­lit­i­cal fight to boost low vac­cine rates con­tin­ues.

Los Angeles Times - - FRONT PAGE - By Rong-Gong Lin II and Pa­trick McGreevy

SACRA­MENTO — Cal­i­for­nia of­fi­cials on Fri­day de­clared the end of the Dis­ney­land measles out­break, but the po­lit­i­cal battle over im­mu­niza­tion that it sparked con­tin­ues to rage on.

In an­nounc­ing that the health scare had passed, state med­i­cal au­thor­i­ties warned that Cal­i­for­nia re­mains at high risk of an­other out­break be­cause im­mu­niza­tion lev­els in some com­mu­ni­ties re­main so low.

The state epi­demi­ol­o­gist, Dr. Gil Chavez, said im­mu­niza­tion rates in some schools are at 50% or lower, cre­at­ing an ideal en­vi­ron­ment for the virus to spread quickly. A study pub­lished in JAMA Pe­di­atrics last month cal­cu­lated that the measles virus that caused the out­break spread in ar­eas where vac­ci­na­tion rates were likely be­tween 50% and 86%.

But it re­mains un­clear how much the Dis­ney­land out­break changed at­ti­tudes about im­mu­niza­tion.

State leg­is­la­tion in­tended to in­duce more par­ents to get their chil­dren the measles vac­cine and other shots stalled this week amid an out­cry from anti-im­mu­niza­tion forces who said the gov­ern­ment should not tell par­ents what to do.

The de­bate on the bill has turned con­tentious. Last week, Robert F. Kennedy Jr., a lead­ing anti-vac­cine ac­tivist, used the word “holo­caust” dur­ing a film screen­ing to de­scribe the pur­ported dam­age done by vac­cines to many re­cip­i­ents, a state­ment for which he later apol­o­gized.

State Sen. Richard Pan (D-Sacra­mento), a pe­di­a­tri­cian who is push­ing for greater vac­ci­na­tion, has been bom­barded with per­sonal at­tacks. One In­ter­net post­ing im­posed a Hitler mus­tache on Pan’s face; an­other said: “Can we hang Pan with a noose in­stead?”

While there has been a surge in vac­ci­na­tions amid in­tense me­dia fo­cus on the is­sue, health of­fi­cials say the im­mu­niza­tion prob­lems are so bad in some com­mu­ni­ties

that a ma­jor out­break could eas­ily hap­pen again.

The idea that the measles vac­cine was linked to autism has been thor­oughly dis­cred­ited by sci­en­tists. Still, measles vac­ci­na­tion rates in Cal­i­for­nia’s kinder­garten classes have been de­clin­ing over the last dozen years.

Among those whose vac­cine sta­tus was known, about 7 out of ev­ery 10 Cal­i­for­nia measles pa­tients in this out­break were un­vac­ci­nated. “If we had higher lev­els of im­mu­nity in the com­mu­nity, this out­break would not have hap­pened,” Chavez said.

The Dis­ney­land out­break sparked an ag­gres­sive re­sponse from health of­fi­cials across Cal­i­for­nia and be­yond that ex­perts say helped keep the dis­ease from spread­ing even fur­ther.

Public health of­fi­cials con­tacted thou­sands of Cal­i­for­ni­ans in 12 coun­ties po­ten­tially ex­posed to measles, lead­ing to warn­ings in air­ports, malls, schools, clin­ics and hos­pi­tals. In one hos­pi­tal alone, a sin­gle per­son with measles ex­posed 14 preg­nant women and 98 in­fants, in­clud­ing 44 in the neona­tal in­ten­sive care unit.

One lo­cal agency es­ti­mated spend­ing 1,700 hours on the measles in­ves­ti­ga­tion.

About 1 in 5 who got the measles in Cal­i­for­nia had to be hos­pi­tal­ized. One col­lapsed at home, was placed on a me­chan­i­cal ven­ti­la­tor due to se­vere pneu­mo­nia and de­vel­oped mul­ti­ple or­gan in­jury. An­other suf­fered acute re­s­pi­ra­tory dis­tress syn­drome and had to be treated with an ex­per­i­men­tal drug that re­quired spe­cial ap­proval from the Food and Drug Ad­min­is­tra­tion.

In all, 131 Cal­i­for­nia res­i­dents were be­lieved to have been in­fected with measles dur­ing the out­break that be­gan at Dis­ney­land, as well as at least 26 peo­ple who resided in seven other states, Canada or Mex­ico, af­ter vis­it­ing the Ana­heim theme park or catch­ing the virus from some­one who went there.

Ex­perts cred­ited public health of­fi­cials with rec­og­niz­ing the out­break early and ag­gres­sively mov­ing to iden­tify the sick and iso­late those ex­posed to the virus, giv­ing out im­mu­niza­tions and other medicine to the ex­posed to keep the dis­ease from spread­ing.

“It’s over, and it’s due to in­cred­i­bly good public health,” said Dr. James Cherry, a UCLA pro­fes­sor and pri­mary edi­tor of the Text­book of Pe­di­atric In­fec­tious Dis­eases.

The out­break prompted two state law­mak­ers, Sens. Pan and Ben Allen (D-Santa Mon­ica) to push for closing a loop­hole in state law that gives par­ents the right to refuse state-re­quired vac­ci­na­tions due to their per­sonal be­liefs while still send­ing their chil­dren to public and pri­vate schools.

Early on, the bill ap­peared to have mo­men­tum, win­ning ap­proval of the Se­nate Health Com­mit­tee af­ter Gov. Jerry Brown sig­naled he was open to con­sid­er­ing an elim­i­na­tion of all but med­i­cal waivers to vac­cines.

But SB 277 stalled this week in the Se­nate Ed­u­ca­tion Com­mit­tee, where mem­bers de­manded changes af­ter hun­dreds of par­ents lined up to say they would pull their kids out of school if the bill passed. A vote is sched­uled for Wed­nes­day.

“There is a prob­lem in deny­ing a child a public ed­u­ca­tion,” said Jean Munoz Keese, a spokes­woman for the Cal­i­for­nia Coali­tion for Health Choice. Re­fer­ring to the an­nounce­ment that the measles out­break had ended, she said, “It con­firms what we have said all along: that we have no cri­sis.”

The bill faces a dif­fi­cult fu­ture, said Larry Ger­ston, a po­lit­i­cal science pro­fes­sor at San Jose State Uni­ver­sity.

He said the op­po­si­tion is a blend of lib­er­tar­i­ans sus­pi­cious of any­thing the gov­ern­ment man­dates, peo­ple who be­lieve in “nat­u­ral health” reme­dies and worry vac­cines will harm their kids, re­li­gious peo­ple and par­ents who don’t have the means to home-school their chil­dren if they don’t get a waiver.

“That’s quite a com­bi­na­tion,” Ger­ston said. “One or two of th­ese in­ter­ests might not be enough to stop the leg­is­la­tion, but this many dif­fer­ent sources of op­po­si­tion, Pan and his al­lies have their hands full.”

Pan and Allen say they be­lieve they can sal­vage their leg­is­la­tion and are will­ing to con­sider al­low­ing some kind of re­li­gious ex­emp­tion, though Allen said he knows of no main­stream reli­gion that is doc­tri­nally against vac­cines.

“There is still an ab­so­lute con­sen­sus amongst folks in the med­i­cal and sci­en­tific com­mu­ni­ties that we have let our vac­ci­na­tion rates drop too low and that any at­tempt to in­crease the vac­ci­na­tion rate is an im­por­tant thing to do,” Allen said.

There are other ways to achieve higher vac­ci­na­tion rates. One idea is to make it harder to get a vac­cine ex­emp­tion, said Saad Omer, an as­so­ciate pro­fes­sor at Emory Uni­ver­sity and ex­pert in vac­cine pol­icy.

For in­stance, the state could re­quire par­ents at the be­gin­ning of ev­ery school year to write a let­ter ex­plain­ing why they don’t want to vac­ci­nate their child, and re­quire it to be no­ta­rized and the par­ents to be coun­seled by a physi­cian on the risks of not vac­ci­nat­ing.

New York City’s public school sys­tem, for ex­am­ple, re­quires par­ents to sub­mit a writ­ten ex­pla­na­tion of re­li­gious prin­ci­ples that guide ob­jec­tions to im­mu­niza­tions. Un­der New York state law, the school sys­tem can re­ject a re­quest for an ex­emp­tion, and it tells par­ents that state law does not per­mit ex­emp­tions based on per­sonal, moral, secular or philo­soph­i­cal be­liefs.

A fed­eral ap­peals court in Jan­uary up­held the New York law as con­sti­tu­tional.

Mel Mel­con Los An­ge­les Times

DAISI MI­NOR, left, gives a measles, mumps and rubella vac­cine to Kris­tian Richard while his mother, Natasha, holds him at a med­i­cal fa­cil­ity in L.A.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.