Does the Recent Measles Outbreak Have a Silver Lining for the Pro-Vaccine Cause?

Written by on April 1, 2015 in Insight - No comments

The vaccination debate has been going strong for years. It has recently received even more attention with the recent measles outbreaks, including one stemming from Disneyland that has affected over 140 children in at least seven states as of early March.

The mismatch of this year’s influenza vaccine and the prevalent strain fueled some anti-vaccine concerns.

With poor coverage of the prevalent strains this winter, the effectiveness of the influenza vaccine has been reduced to about 20%¹.This brings up the argument, “The vaccine doesn’t even work, why should we get it?”

measlesWEBUnfortunately, with influenza vaccination, this is sometimes the case. Despite best efforts to match strains, sometimes they get it wrong.

However, this shouldn’t affect people’s decisions on vaccinating for influenza in future years, and certainly not for vaccinating for other serious illnesses such as measles, for which the vaccine is about 98% effective and is long-lasting.

Parents report a variety of reasons for refusing vaccines for their children.

Rarely, a child has a medical contraindication or has had a severe adverse reaction from a vaccine–this can be a valid reason for declining certain vaccines.

However, this is the minority. Most of the other reasons for not vaccinating are not based on evidence-based science–such as concerns that vaccines contain “toxins” or will overwhelm their child’s immune system, or that vaccines often cause major harm, such as autism and even death.

They don’t realize the seriousness and contagiousness of the vaccine-preventable diseases–since we almost never see them thanks to the efficacy of most current vaccines.

They often harbor mistrust and feel that we (doctors, pharmaceutical companies, or the government) are only interested in the money, are telling them what to do, or worse, somehow out to harm them.

They believe in the “n of 1”i.e., “my child doesn’t get vaccines and doesn’t get sick” or, “my child got sick after getting the vaccine” instead of the results of large, scientific, evidence-based studies. Unfortunately, the one study parents opposed to vaccines seem to trust is the study linking autism with the MMR vaccine by Andrew Wakefield–which we now know to be fraudulent and which has been fully retracted and discredited.

However, much of the vaccine debate is actually related to personal freedoms and rights more than actual vaccine risks, especially when considering vaccination for herd immunity.

Parents ask, “Why should my child have to get the vaccine to protect yours?” They fail to realize that the 95% or more of children getting the vaccines are already protecting their children as well as their own.  They benefit from herd immunity, but by not vaccinating, put the whole herd at risk. How do we decide which child–the child who is not vaccinated (and putting others at risk)–or the child who is at risk due to age or immune status–should be able to attend school or daycare? Don’t children have a right to go to school, daycare, and even Disneyland, without being exposed to vaccine-preventable diseases?

With the recent measles outbreak, many children unvaccinated by choice are among those getting sick, and parents are facing more pressure to vaccinate.

Now that we are seeing more cases of measles, chances increase that unvaccinated children will get infected. They are affected by herd immunity just as much as they are responsible for it.

Will seeing how serious and highly contagious measles actually is help parents rethink their positon?  And will increasing pressure to vaccinate or face consequences affect their choice?

In 2014, the US saw a record number of measles cases, with 644 cases from 27 states reported to the CDC–the greatest number of cases since the elimination of measles was documented in the U.S. in 2000². The majority of people who got measles were unvaccinated.

Measles is one of the most highly contagious organisms–it is easily spread through the air, and it can live on surfaces and in the air for up to two hours. So if a child with measles is in a classroom, daycare, or doctor’s waiting room, people are at high risk even two hours after the child leaves. And, as children are most contagious several days before the rash occurs, parents aren’t usually aware they have measles and aren’t taking precautions not to expose others. In addition, besides causing typical symptoms of high fever, cough, runny nose, rash, and conjunctivitis, measles infection can lead to complications such as ear infections, pneumonia, encephalitis, hearing loss, and rarely, even death.

This recent measles outbreak has brought the vaccine debate, and the debate about rights, back in the spotlight–in the news, on TV, and on social media. A new article is posted almost every day, with titles such as “The Return of the Vaccine Wars³.”

For some time, those who refused vaccinations seemed to have the upper hand. More schools and daycares, even doctors’ offices, bended to the wishes of parents and allowed unvaccinated children in the name of parents’ rights. But things seem to be changing.

People are getting scared–and angry. Parents with babies too young to vaccinate or children with weakened immunity already have enough to worry about–now they have to worry about measles because someone chose not to vaccinate their children. There are more stories about children with cancer or other conditions asking for THEIR rights. Parents with unvaccinated children causing others to be infected are facing blame. And more schools, daycares, and even doctors’ offices are becoming stricter in requiring vaccines to be admitted.

Currently, all states allow exemptions of vaccinations for medical reasons, and all but two states allow exemptions for religious reasons. Many states allow parents to decline vaccinations for ill-defined philosophical reasons.

However, partly in response to the recent measles outbreaks, lawmakers in at least ten states–including California–are promoting legislation that would make it harder for parents to obtain exemptions to vaccination.  This includes requirements for parents to meet with a healthcare provider to obtain information on the risks and benefits of immunization to their child and others, for school staff to be fully vaccinated except for medical reasons, and for schools to post immunization rates. The most restrictive laws would eliminate philosophical exemptions and even limit religious exemptions.

It’s unfortunate that it takes children getting sick from vaccine-preventable diseases such as measles to change the culture. But perhaps this is the silver lining to the recent outbreaks. Instead of children at risk being required to be homeschooled or being isolated, it’s time for those who choose not to vaccinate to make the sacrifice. Parents can still exercise their rights and choose not to vaccinate their children, but they and their children will face consequences that may cause them to rethink this decision, including denial of attendance at school and daycare…and even Disneyland.

Of course the best outcome would be for parents against vaccination to hear and truly understand the evidence that clearly shows that the benefits of vaccines far exceed the risks for their children and for others–and to fully vaccinate their children.

Resources:

  1. http://www.cdc.gov/flu/news/updated-vaccine-effectiveness-2014-15.htm
  2. http://www.cdc.gov/measles/cases-outbreaks.html
  3. http://www.wsj.com/articles/the-return-of-the-vaccine-wars-1424463778

By Laura E. Marusinec, MD
Urgent Care Pediatrician

Laura Marusinec is a board-certified pediatrician and medical writer with experience in general pediatrics, pediatric dermatology, and pediatric urgent care.

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