To recap what’s been going on nationally with the measles outbreak of 2019, as of March 12 there were 71 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.
There are already more than 350 confirmed cases of measles this year, on pace to shatter last year’s total of 372, according to the U.S. Centers for Disease Control and Prevention. In New York City, 158 cases have been confirmed, along with 145 in Rockland County, New York. Elsewhere, Texas has recorded 11 outbreaks; Oregon, six; Illinois, five; and California, three. The number change and increase daily.
Measles tends to spread only to those people who have not been properly vaccinated against the disease. The vaccination 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 to get their children immunized. According to the CDC, 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 state Department of Public Health’s 2017-18 Kindergarten Immunization Assessment.
Based on the assessment, the overall all required vaccine (ARV) rate in California 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 percent. Marin’s ARV rate is 94 percent. It should be noted that while Marin is below the California average, the county’s school vaccination rates have increased from 79 percent in 2012 to 94 percent in 2018, due to education and policy change, one of the most dramatic increases in the state. San Francisco County is also at 94 percent. For context, Alameda County 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 high rates. Exceptional schools tend to coalesce parents with a 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 more, alternative medicine physicians are becoming more prevalent in many communities. These types of medical exemptions have climbed since 2014 (from under 0.5 percent to about 2 percent of private school students).
These schools have children where diseases like measles could spread quickly. It should also be noted that while Marin and San Francisco vaccination rates may be lower than the California average, the lowest ARV rates are in rural counties, with Mendocino at 86.8 percent, Humboldt at 88.4 percent, Calaveras at 88.1 percent, Nevada at 81.7 percent, Sutter at 78.2 percent and Trinity at 84.5 percent.
In its “Ten Threats to Global Health in 2019,” the World Health Organization cites vaccine hesitancy as a threat to the progress made in tackling vaccine-preventable diseases. WHO reported, “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 Rep. Bill Zedler, suggest that measles can be treated with antibiotics, or Arizona 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 United States 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, of San Rafael, is medical director of the antimicrobial stewardship program at Marin General Hospital and director of infection control at Novato Community Hospital.