Experts: Spring break brings new risk for measles exposure
The discovery of two possible cases of measles in Portage County is bringing renewed attention to the re-emergence of the disease after it had been essentially eradicated in the United States for more than a decade.
One of those cases tested negative and the results are pending for the second. However, the arrival of the cases on the heels of a multi-state outbreak in December has added urgency to an ongoing discussion of vaccines, their risks and the decisions of some parents not to vaccinate their children.
State health officials and medical providers said immunizations remain the best way to protect against vaccine-preventable diseases. That's especially true as Wisconsinites prepare to travel outside of the state for spring break, where the risk of exposure to the disease increases.
All children in Wisconsin are required to have chicken pox, measles/mumps/rubella, hepatitis B, polio and diphtheria/pertussis/tetanus vaccinations, although some parents obtain waivers from the state for personal, religious or medical reasons.
In 2013, 4.8 percent of children in school did not get the MMR vaccine, according to the state Department of Health Services. Five of Wisconsin's 72 counties — Forest, Iron, Juneau, Kewaunee and Sheboygan — had a vaccination rate of more than 90 percent, while two counties — Clark and Vernon — had less than 70 percent, a review of state records found.
Health care providers say they want to increase those percentages to the point at which any potential outbreaks become unsustainable. Part of that solution is to educate parents about the importance of getting their children vaccinated.
The state recommends parents discuss vaccinations with their medical provider or local health department as part of regular well child visits, said Dan Hopfensperger, director of the Wisconsin Immunization Program.
"Far be it from us to say that they aren't (valid concerns)," Hopfensperger said. "That's why we strongly suggest that they have those discussions with their providers. ... We don't want to imply that the information they're getting is (flawed), but there's a lot of (web)sites out there, and we want to make sure that the information is based on sound medical science."
Dr. Andrew Collins, a pediatrician at ThedaCare Physicians in Oshkosh, said he likes to start having those discussions with parents at a child's two-month visit and suggests following the annual guidelines from the American Academy of Pediatrics and the Centers for Disease Control and Prevention.
"With the younger ages like that, when you actually give (the vaccinations), they can be harder on the parents than the children," Collins said.
The Wisconsin Department of Health Services follows the CDC recommendation, which suggest the MMR vaccine be administered at 12 months, with a second dose at 4 to 6 years, Hopfensperger said. While the vaccine could be administered to children as young as 6 months, especially in the event of an outbreak, children typically retain any immunity to the disease from their mothers for the first year.
"If the mother is vaccinated, it will carry over," he said.
Those who have had measles already have life-long protection, Hopfensperger said, noting anyone born before 1957 probably has had a natural infection and probably does not need to be immunized.
Choosing not to vaccinate
Hopfensperger said there are many reasons why children don't get vaccinated, ranging from existing medical conditions that make vaccines intolerable to concerns about the additives in the vaccines, as well as a desire to take a holistic approach to healthcare.
"If we eat the proper foods and get enough sleep ... you are going to prevent yourself from having a communicable disease. ... That can be a very chancy approach," he said.
Probably the most well-known and controversial example is what experts call an unfounded correlation between vaccinations and autism. In 1998, the British medical journal The Lancet published a study by Dr. Andrew Wakefield and 12 others that linked the MMR vaccine to autism, but 10 of the study's original 13 authors later retracted the findings. The Lancet retracted the study in 2010, though Wakefield still contests accusations that his work was faulty or purposely misrepresented the facts.
"That article has been totally discredited because of inaccuracies, and that author has actually lost his medical license," Hopfensperger said. "It really started the ball rolling, and people ... have bought into it and are not willing to back and accept that it's not true."
The American Academy of Pediatrics, the Institute of Medicine and the CDC all state there is no correlation between the MMR vaccine and autism, citing studies in the Journal of Pediatrics, the American Journal of Preventive Medicine, the New England Journal of Medicine and the Journal of Autism and Developmental Disorders.
While health officials understand some parents' lingering hesitation, they still encourage getting vaccinated as the best way to prevent the disease, said Rachel Gallagher, president of the Wisconsin Association of School Nurses and a school nurse in Madison.
"We strongly support vaccinating children, and we understand that parents are often in a dilemma where they're fearful of the results of vaccines, but when we look at some of the things in public health that have made a difference in the country, immunization is really high," Gallagher said.
The association also is encouraging state leaders to explore different processes for the opt-out waivers, including a possible provision that requires the information parents get about opting out to come from reputable sources, Gallagher said.
Strength in numbers
Although experts admit that achieving 100 percent vaccination rate is not realistic or even feasible, the more people who are vaccinated, the lesser the likelihood that those who are un-vaccinated will contract the disease.
Known as "herd immunity," the concept serves as a safeguard for people who can't be vaccinated, either because they're too young or have adverse reactions to vaccines. According to the CDC, herd immunity occurs when a significant portion of the population is vaccinated against a contagious disease, thus giving some protection to the other part of the population that is not immunized.
"You're not only protecting your child from contracting a vaccine-preventable disease, you're preventing them from passing it on to someone else," Hopfensperger said, calling the concept "social responsibility." If an area has a vaccination rate of more than 90 percent, a measles outbreak likely will not be sustainable, he said.
"While we may not be experiencing diseases here, it's not uncommon to have measles and vaccine-preventable diseases imported from other areas," he said. "You still could have the disease introduced into a community ... but it's not going to get anywhere."
Those who are not able to be vaccinated — individuals with compromised immune systems, such as those who have leukemia, are undergoing chemotherapy or have some other form of immune deficiency — should minimize their exposure by avoiding public places with large crowds, such as water or theme parks, where infected people can spread the disease through coughing and sneezing, said Melanie Baehr, a nursing supervisor for the Portage County Health and Human Services Department.
"Spring break is coming up, so people should be very vigilant about things like covering their mouths," Baehr said.
Vaccinations remain the most effective form of preventing the disease, Collins said. One dose of the vaccine, typically administered at 12 months, provides about 95 percent protection, and getting a second dose at between 4 and 6 years old before the child enters school increases that level of protection to about 99 percent.
"Measles is one of the most contagious viruses known to man," Collins said, noting the virus can spread even before the person shows any symptoms, which start with a fever, runny nose, cough, red eyes and sore throat. A red rash then develops and spreads over the body.
Measles through the years
Measles became a federally reportable disease in 1912, and in the first decade health care providers reported an average of 6,000 measles-related deaths each year, according to the CDC. In the 1950s, a decade before John Enders developed a vaccine, an estimated 3 to 4 million people were infected each year, with about 400 to 500 people dying and 48,000 requiring hospitalization.
By 1981, the number of reported cases had decreased by 80 percent, though a 1989 outbreak prompted experts to recommend issuing a second dose to school-aged children, according to the CDC. In 2000, health officials declared the elimination of measles — the "absence of continuous disease transmission for greater than 12 months" — within the United States.
"Many of the parents having children today may not fully realize the true impact of measles," Hopfensperger said.
There were 644 reported measles cases in 27 states last year, according to the CDC. As of Friday, at least 141 people from 17 states, including Illinois, Minnesota and Michigan, were reported to have contracted measles this year. About 80 percent of those cases are the result of an outbreak that started in December and has been traced to Disneyland in California.
Collins and Baehr cautioned residents not to be alarmed just because providers have started testing people in Wisconsin for the disease. With an increased awareness about the symptoms and outbreaks elsewhere in the country, many providers have become more cautious and would rather test all individuals who exhibit symptoms, which are very similar to other illnesses.
As of Monday, only one of the two suspected measles patients remained in isolation after preliminary tests for the other individual came back negative, Baehr said. She expected a second round of tests results on the remaining patient — both were younger than 5 years old and did not attend public schools or day cares — by sometime on Wednesday.
Baehr would not say whether the children were vaccinated for measles. Based on their age, though, the children would have received at most one of the two doses required for the vaccine to be effective, she said.
"Certainly, there are some other (patients in Wisconsin) who have been tested," Collins said. "The fact that somebody has been tested for it doesn't necessarily mean there's an outbreak."
Nathaniel Shuda: (920) 426-6632 or email@example.com; on Twitter @onwnshuda. Chris Mueller of Stevens Point Journal Media contributed to this report.
On the web
Gannett Wisconsin Media will host two chats at 1 p.m. and 7 p.m. Wednesday designed to answer your questions about the measles, vaccinations and other related health issues.
We will be joined by Winnebago County Health Director Doug Gieryn for both chats and at 7 p.m. by Dr. Sharon Rink, a pediatrician with ThedaCare in Darboy.
Join the discussion at www.thenorthwestern.com.