Vaccination built on public trust
An outbreak of measles can put it to the test
The widening measles outbreak has prompted public health officials to take extraordinary measures to limit the spread of the highly contagious virus.
New York City will make unvaccinated people in high-risk Brooklyn ZIP codes get immunized or pay a fine. Schools in Clark County, Washington, have barred hundreds of unvaccinated students from class and school events during an outbreak there.
And hospitals in some communities are screening kids who have a fever or rash in the nation’s second-worst outbreak since measles was declared eliminated in 2000.
But what about people who can’t – or shouldn’t – get vaccinated?
At the heart of vaccination is a compact of public trust. Parents vaccinate their kids to protect them from preventable diseases. That protection also helps shield others who can’t vaccinate because of age, a weakened immune system or a medical treatment such as chemotherapy or radiation.
Widespread vaccination creates herd immunity that protects both the healthy and the vulnerable who are unable to protect themselves – perhaps a “more morally compelling reason” to vaccinate, said David Kimberlin, co-director of the division of pediatric infectious diseases at the University of Alabama Birmingham.
“Measles will not only seek out those who have refused vaccination, it will seek out those who did get vaccinated but their immune system didn’t take to the vaccine,” Kimberlin said. “And it will find the children who couldn’t get vaccinated because their immune system was simply too weak to be vaccinated in the first place.”
With 465 cases in 19 states this year as of April 4, new measles infections are on pace to shatter this century’s high
mark of 667 cases in 2014. That is why health officials are taking steps to prevent an even more widespread outbreak that could sicken both the healthy and the vulnerable who can’t be vaccinated.
Infants are most susceptible
The Centers for Disease Control and Prevention recommends children get the first dose of the measles, mumps and rubella vaccine at age 12-15 months. The second dose is recommended at age 4 to 6. Infants collectively represent “the most susceptible group,” said Frank Belmonte, pediatrician and Chief Medical Officer of Advocate Children’s Hospital near Chicago.
When the first case of measles in Cook County, Illinois, was identified this year, Advocate and NorthShore University Health System searched its electronic medical records systems to identify families of children who have skipped or delayed immunizations. The network will send hundreds of letters to those families next week to encourage them to get vaccinated.
Belmonte said the hospital will try to schedule immunizations for parents as soon as possible.
“We are trying to be proactive, especially (with) those kids who just turned 1,” Belmonte said. “With the confirmed cases in the state, we’re saying ‘Let’s get it now so your child is protected.’ “
But infants are not the only group at risk in an outbreak. Those with an immune system weakened by cancer, HIV or tuberculosis might not be able to be vaccinated. The same is true for those having chemotherapy, radiation, immunotherapy or steroid treatments.
The CDC says others who should not get immunized include those who have had a life-threatening allergic reaction to the measles vaccine or those with a weakened immune condition.
A small percentage of children don’t get the protection they need from the first dose of the measles vaccine, and they can be vulnerable if they are in a preschool or other setting where they are exposed to measles.
“That’s why herd immunity is so important,” Belmonte said. “If everyone vaccinates, even those who don’t respond (to the measles vaccine) are safe because we’re not bringing measles into the population.”
Some parents choose to skip the measles vaccine or other immunizations over personal beliefs or fears that their child can have an adverse reaction. Multiple studies, however, have shown the measles vaccine to be safe and effective.
In declaring an emergency in New York City, Health Commissioner Oxiris Barbot said the outbreak was being “driven by a small group of anti-vaxxers” who have spread “dangerous misinformation based on fake science.”
A community responsibility
Families of children who can’t be immunized because of a weakened immune system often become worried during outbreaks, said Karen Ernst, executive director of Voices for Vaccines, a parent-led nonprofit that advocates for on-time vaccinations.
Ernst said she tries to ease parents’ concerns by providing facts about measles and steps they can take to protect their children.
Still, she said, state laws on vaccine exemptions and school responses to outbreaks vary greatly. While schools in Clark County, Washington, can prevent unvaccinated children from returning to class during an outbreak, not all states empower their schools to take such actions, Ernst said.
And though outbreaks might motivate more parents to vaccinate their kids, that sentiment can fade quickly.
“People seem to have amnesia about measles outbreaks pretty quickly after they end,” Ernst said. “It’s not surprising we have this patchwork of immunization rules after we eliminated measles from the United States.”
Parents should be motivated to protect their own kids from disease, but there’s a larger community responsibility, Kimberlin said.
A single person with measles can infect 16 to 17 others because the virus is so contagious. Infants or people with cancer or an immune condition can be especially vulnerable, he said.
“They are relying on others to do the right thing,” Kimberlin said. “When you get something like measles coming into a community, you have to have virtually everybody doing the right thing.”