To recap what’s been going on nationally with the measles outbreak of 2019, as of February 23, there have been 66 confirmed cases of the disease in Washington state. Clark County is said to be the epicenter of the outbreak and Washington state officials have declared a state of emergency. Since the first case was reported on Dec. 31, 2018, the disease has shown up in Oregon, where, as of February 25, there were six confirmed cases.
Measles tends to spread only to those people who have not been properly vaccinated against the disease. The vaccination that’s used is referred to in medical jargon as MMR, which stands for measles, mumps and rubella. And vaccination is currently the only way to prevent measles. On a positive note, the news reporting around this latest outbreak appears to have started to get many in the anti-vaccination camp motivated get their children immunized. According to the Centers for Disease Control and Prevention, 7.5 percent of kindergarten age children in Washington were unvaccinated for non-medical reasons.
In California, most communities are doing an effective job and ensuring public-school educated children are vaccinated, but there’s still work to be done. Evidence of California state and county vaccination rates can be found in the 2017-2018 Kindergarten Immunization Assessment.
Based on the assessment, the overall all required vaccine (ARV) rate in CA was 95.1 percent in 2018. This has climbed from around 90 percent in 2014. Marin and San Francisco counties remain in the yellow range, however, with MMR vaccination rates that are below 95%. Marin and San Francisco ARV is 94 percent. For context, Alameda is at 97.1 percent, and San Mateo is at 96.9 percent.
I believe the lower vaccination we’re seeing in San Francisco and Marin has to do with pockets of certain private schools. Public schools generally have very high rates. Exceptional schools tend to coalesce parents with history of vaccine refusal. In my observation, parents scoot around the system by finding a physician to sign off for their child’s medical exemption and therefore filling criteria for Senate Bill 277.
What’s more, Alternative medicine physicians are becoming more prevalent in many communities. Thesetypes of medical exemptions have climbed since 2014 (from 0.5 percent to ~ 2% of private school students).
In its “Ten threats to global health in 2019,” the World Health Organization (WHO) cites vaccine hesitancy as a threat to the progress made in tackling vaccine-preventable diseases. WHO says,
“Vaccination is one of the most cost-effective ways of avoiding disease — it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.”
It’s sad to see elected officials, such as Texas state representative Bill Zedler, suggest that measles can be treated with antibiotics, or Arizona’s State Rep. Kelly Townsend suggest that mandatory vaccination is communist. I’m further dismayed that people believe non-rigorous explanations or hearsay for vaccine refusal. It should be noted that on March 5, The Annals of Internal Medicine published a comprehensive report that found no correlation between vaccination and autism. For those who still need further evidence of the power of vaccines, look at the statistics of deaths in the US in the early 1900s; most if not all of them were related to vaccine preventable conditions. If you haven’t done it yet, get your children vaccinated ASAP.
Dr. Alexander Evens is the Medical Director of the Antimicrobial Stewardship Program at Marin General Hospital and director of Infection Control at Novato Community Hospital.