Doctors say measles outbreak should be warning for parents, schools and vaccine skeptics
CLEVELAND — The recent Ohio measles outbreak — which so far has been limited entirely to unvaccinated or partially vaccinated children — has some doctors raising concerns that go beyond measles.
They say a combination of a complacency about diseases most people in the U.S. have rarely seen up close, and the heated debate around COVID-19 vaccinations, has sown seeds of confusion and misinformation about the safety, effectiveness and necessity of vaccines for other childhood diseases.
These small outbreaks, say doctors, should serve as a reminder of the importance of timely vaccinations in young children, because even a single exposure could be devastating in settings like daycares with rooms full of babies too young to be vaccinated. Measles is a highly contagious virus, with 90% of unvaccinated people exposed getting sick.
“Measles and polio and meningitis ... these are very serious diseases that we do not want to see come back,” said Dr. Camille Sabella, a specialist in pediatric infectious diseases at the Cleveland Clinic. “Vaccines have basically eliminated those childhood diseases.”
Seventy-seven cases of measles were reported Central Ohio from Nov. 9 through Friday.
All the cases involved people under 18, concentrated among young children. Seventy-two cases involved children under 5, including 20 who were not yet a year old. None of the children was fully vaccinated against measles. Four were partially vaccinated, having received only the first dose of the two-dose series, and the rest had never been vaccinated.
Children must wait until 12 months of age to be vaccinated. There have been no reported deaths in Ohio, but more than a quarter of the patients required hospitalization.
Globally, measles cases reached a record of nearly 900,000 in 2019, and deaths from measles topped 200,000.
The CDC reports that the U.S. had more than 1,274 confirmed cases across 31 states that same year, the largest resurgence of the disease since 1992.
Those numbers dropped dramatically during the pandemic. There were only 13 reported cases of measles in the U.S. during 2020, presumably as a result of lockdowns, social distancing and masking precautions.
But the pandemic delayed routine medical visits, causing some children to fall behind in their routine vaccination schedules, and stalling worldwide efforts to quell the rising tide of measles through large-scale vaccination efforts.
Now that COVID-19 restrictions have been loosened, those numbers are starting to rise again.
In countries like Madagascar, the Ukraine, India and the Philippines, where vaccination rates are typically between 60% and 80%, measles still infects anywhere from 50,000 to 100,000 people per country every year.
But here in the United States, measles by health standards is considered eliminated, in that it has not spread continuously in the country for over two decades. Roughly 92% of children in the U.S. have received two doses of the MMR vaccine by 24 months of age, a number that hovers just below the 93%-95% vaccination rates required to prevent the spread of the disease.
Measles is occasionally brought into the country via exposure to a person who has traveled to a country where measles is still widespread, causing small outbreaks among unvaccinated individuals like the one in the Columbus area.
However, slipping vaccination rates amid dangerous anti-vaccine misinformation and pandemic-related disruptions to health care could push the U.S. toward a resurgence of endemic measles, doctors say. During the lengthy outbreak in 2019, the U.S. nearly lost its elimination status, and there’s cause for concern this could happen again.
The U.S. Centers for Disease Control and Prevention recently warned about a drop in measles vaccination coverage in children during the COVID-19 pandemic, estimating that 40 million kids missed a measles-containing vaccine in 2021, including 25 million who missed their first dose and 14.7 million who missed their second dose.
In a Nov. 30 news conference, Mysheika Roberts, public health commissioner for Columbus, said at least 25% of the area’s 2-year-olds were unvaccinated, and that the most important thing parents could do to protect their children was to ensure that they are up to date on all their vaccines.
The Columbus health department also launched a multi-cultural campaign to raise awareness.
In sharp contrast to the pro-vaccination efforts of the city’s health department, other groups are working to get the Ohio legislature to ban mandated vaccinations.
Last fall, an Ohio law went into effect that blocked public schools and colleges from requiring any vaccine that has not been fully approved by U.S. Food and Drug Administration. The law primarily took aim the COVID-19 vaccines, which have only been approved for emergency use.
Since then, there have been other efforts aimed at banning, or rolling back, vaccine mandates imposed by businesses, health care providers and governments, including schools.
“All vaccines are not created equal,” said Sabella. “If we removed vaccine mandates for things like polio and measles and meningitis, that would be a horrible, horrible thing.”
“That is one of the problems that has come up from the Pandemic. This has opened the door now for people to question all vaccines . ... there really shouldn’t be differing opinions about vaccines for things like measles and polio and meningitis,” Sabella said.
Sabella said many people may not realize how serious it can be. Measles can result in severe, sometimes permanent, complications including pneumonia, seizures, brain damage, and even death.
But while it’s one of the most contagious human viruses, it’s also almost entirely preventable through vaccination. Just one dose of the measles vaccine provides 95% protection for life, and after two doses the protection is over 99% effective, Sabella said.
“That’s a point I don’t think we’ve really made clear ... and that’s really unfortunate,” Sabella said. “People equate vaccines to the flu vaccine and the COVID-19 vaccine which are not nearly as effective, and certainly do not prevent infection and transmission.”
COVID-19 and flu vaccine still have huge benefits, but for most healthy children, Sabella said measles is significantly more deadly and leads to more serious complications.
“It’s so important that we continue to give those routine childhood vaccinations, and hopefully this Columbus outbreak is going to wake some people up,” Sabella said.
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