Measles: Is Your Child at Risk?

Measles is back in the news after a late 2014, early 2015 outbreak that began at Disneyland in California in December and made it's way into the lives of 154 people in several states by the end of February. Measles was declared eliminated in the United States in 2000. Eliminated, in this context, means that the vaccine coverage was high in order to achieve herd immunity (where the entire population is protected because of the immunization status of the masses) and the public health response to a case of measles was quick and strong. Eliminated means that there was a reduction to zero of the incidence of the infection (measles) as the result of deliberate efforts, but continued intervention (i.e. vaccination) is necessary.

The goal of any public health program focusing on any disease is treatment if necessary, prevention if possible, followed by elimination and eradication (defined as a permanent reduction to zero, worldwide, making intervention efforts unnecessary). Fast forward to 2014 when there were 644 cases of measles in the United States. Why has this happened when measles was previously eliminated? Why is measles a threat once again? Enter the "vaccine debate."

Is the measles infection dangerous? Is the MMR vaccine safe? Why are some people opposed to vaccines? Is your child at risk for once eliminated diseases in this area and what are the laws in New York State to protect freedom but also protect the most vulnerable populations?

Why are measles dangerous?
The CDC states the following on its website: Measles is highly contagious and spreads to others through coughing and sneezing. The virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. Infected people can spread measles to others from four days before to four days after the rash appears. Measles can be a deadly disease and is the most deadly of rash/fever illnesses in children. Thirty percent of children are hospitalized with measles. Short-term side effects of the disease include ear infections that may result in permanent hearing loss, encephalitis, and pneumonia- the leading cause of death from measles. The long-term side effect of measles, other than hearing loss, is SSPE, a rare but fatal disease of the nervous system. This develops 7-10 years after a person has measles.

Kristin Becht shared her personal story of her 8-month-old son who contracted measles at a daycare in the U.K.

"It was 2008 and we were living in England at the time but came back to the U.S. for Christmas. Our lives were turned upside down when Thomas got really sick the day after Christmas, then got worse and worse. We took him to urgent care then the ER three times and it took days for him to receive a diagnosis. He had developed severe bilateral ear infections, pneumonia in both lungs, and severe viral conjunctivitis, all complications of measles. It was only because my mother-in-law had had measles as a kid and had a "hunch" did it finally lead to some answers. Once we got discharged from the hospital (after four days and nights), we got messages from our daycare that there had been a measles outbreak. We were told an unvaccinated toddler at the daycare became ill and infected one other toddler who was unvaccinated as well as ALL 14 babies in the infant suite who were too young to be vaccinated. I believe seven babies were hospitalized. Ironically, the hospital there turned away twin babies in the ER because the covering doctors were both pregnant. Now here's the part that makes me sick to my stomach as I read about it again. The long-term effects of measles...they can develop even 10-15 years later in a seemingly healthy, recovered child and include hearing loss and a complication called SSPE (subacute sclerosing panencephalitis). SSPE can occur up to ten years after measles and the risk of developing SSPE is higher if one has had measles earlier in life (before age two). It is not common but it is FATAL. Thomas will be seven soon so I have nine more years to continue to be concerned about the long-term side effects of measles.

I am not against people's right to choose to vaccinate their kids but I would also implore that person to consider not putting their kids in a public daycare or another situation that could lead to exposure of kids who are unable to be vaccinated. A person infected with measles is contagious before being symptomatic. I was quite ticked off at that mom and her blatant disregard for the health of the other kids just because she "didn't get around to it." She should have hung out with us while my baby was screaming for two hours straight, then only to go limp and motionless in my arms."

Is the MMR vaccine safe and safe to give on the CDC schedule?
The short but proven answer is yes. The physician who falsified data in The Lancet medical journal (citing the MMR vaccine as causing autism) has had his medical license revoked. Although side effects are possible, most are mild and transient in nature. Doctors report that many parents come in saying of course they're not against vaccinating, that would be crazy, but they want to spread the injections over a longer period of time or separate the vaccines and give the child more injections. "What people failed to realize," said one pediatric doctor, "is that separating the vaccines is only increasing the amount of adjuvants or 'chemicals' as some like to say that are being injected into the child, often the main reason for wanting to separate the shots." The CDC lists side effects to MMR as mostly being rashes or fevers. "In addition, the MMR vaccine has been linked with a very small risk of febrile seizures, most often in children between 12-23 months old. Febrile seizures can happen any time a child gets a fever. Most happen in children 14-18 months old. Because the risk of febrile seizures increases as infants get older, it is recommended that children get vaccinated as soon as recommended (12-15 months old for the MMR vaccine)." By waiting, you may actually be putting your child at increased risk for side effects or for the disease itself in the case of measles. The American Academy of Pediatrics (62,000 physicians strong) is aligned with the CDC vaccination schedule and urges parents to vaccinate and not delay vaccination.

Then why are some people opposed to vaccinating?
The list could go on for a while. I posed the question of vaccination on a couple of "moms" facebook pages in the area and the debate became heated. Here's what I learned.

Misinformation on the internet and scare tactics (like Dr. Sears uses) have worked to put Sears' vaccine book on some best seller lists. Several well-meaning parents quoted Dr. Sears' book as the authority on vaccine information, but fail to recognize or legitimize the criticism that it has garnered -- including incorrect (or spun) statistics, failure to provide full information, and his now famous quote about telling his patients it may be in their child's benefit to avoid vaccination. "I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we'll likely see the diseases increase significantly."

A few moms discussed their distrust of the government and believe the government is excessively lobbied by big pharmaceutical companies who turn a profit in the vaccine business. However, publicly available data shows that big pharma counts vaccines as only 1.82% of their business (profits) -- and even though that number is large in terms of dollars, it's a low priority for lobbyists. Furthermore, sickness causes hospitalizations and visits to the doctor and sickness is treated with medications, so big pharma is "winning" either way if you think that pharmaceutical profits are a reason to avoid vaccination.

Some parents cite the increase in autism, diabetes and asthma as reasons to avoid vaccinations or to alter the vaccine schedule. If you Google "vaccine safety New York," the first two sites that appear are sites dedicated to scaring parents away from vaccinating their kids. There are links all over the pages where people can donate money to help support these sites and allow Google to affix them to the top of a search. For example, one site has a big heading that says "parents, make an informed choice" followed by a table suggesting that vaccines are the reason that autism, learning disabilities, asthma, and diabetes are on the rise. Although it never claims that vaccines cause autism, it display scary statistics that claim that the incidence of autism in the 1990's as 1 in 555 and 1 in 50 in 2013.

Is my child at risk for once eliminated diseases in this area and what are the laws in New York State to protect freedom but also protect the most vulnerable populations? New York State has some of the most stringent vaccine laws in the country. Connecticut and New Jersey have more lenient policies in terms of mandatory vaccinations. Personal or philosophical exemptions are not allowed in New York. A religious exemption must show "genuine and sincere religious beliefs" and have signatures from a clergy or a lawyer then approved (or not). A medical exemption must be certified by a New York licensed medical doctor and must show that immunization may be detrimental to the child's health. Both exemptions must be approved and may be rejected if evidence is insufficient.

Most Westchester area schools have very high (if not 100%) vaccination rates in part because of the difficulty in getting exemptions. However, there are some exceptions. See Lohud for a list of the vaccination rates by school in our area.

Although personal and philosophical exemptions are not currently allowed under New York State law, some politicians are pushing for these exemptions to be permitted Assemblyman Tom Abinanti of Greenburgh was one of the signature creators on a bill designed to allow philosophical and personal exemptions to vaccination. Although he publicly admits that the vaccine-autism link has been fully discredited by over 40 clinical studies, his son has autism and he believes, "...the perceived risk of vaccines is too great to force parents to vaccinate." Furthermore, he is quoted as saying, "There are a large number of kids for whom vaccines are not appropriate, but nobody is looking to see how large the number of people is." I reread that quote several times, but he is claiming there are large numbers of kids for whom vaccines are not appropriate but no one knows what the number is, therefore how can he say the number is large?

I spoke with Abinanti's director of communications, Doug Rosenthal, who did not want to answer any questions on the phone, but said that Assemblyman Abinanti "has removed his name from the bill and that the bill was never meant to be passed anyway.". Rosenthal said "the bill was just meant to open up a discussion and put together a medical board to consider the issue." He did not respond to my follow up emails and phone calls. Although he withdrew his name, his statement said, "I'll be drafting new legislation that calls for the formation of a medical panel that includes the New York State and New York City health commissioners and other public-health officials to consider the best way to protect public health and minimize risk of harm."

What are your views on vaccination? Please comment below and please keep replies to comments respectful.

Scientific sources for accurate vaccine and disease information:

http://www.cdc.gov/vaccines/vpd-vac/measles/
http://www2.aap.org/immunization/illnesses/mmr/measles.html
http://www.vaccinesafety.edu