Sunday, March 1, 2015
By William K. Alcorn
Measles is a nasty, highly infectious, dangerous disease. It is also preventable, local infectious disease specialists say.
But a segment of the nation’s population is opting out of having their children immunized with a vaccine that doctors say is effective and safe.
As a result, measles, declared essentially dead in the United States in 2000, is making a comeback.
Unvaccinated U.S. travelers are contracting the disease in countries that still have a measles problem and bringing it back home, said Dr. John Venglarcik III, medical director of the Mahoning County Health Department.
“Most of the recent measles cases in the United States are a byproduct of exposure at Disneyland Resort in California,” said Dr. Venglarcik, a pediatrician and infectious-disease specialist at ValleyCare Health Systems of Ohio’s Northside Medical Center.
Here is how it can happen.
In Ohio in 2014, unvaccinated Mennonites from Knox County went on a mission to the Philippines not aware of a major measles outbreak there. They returned home and infected some 300 people in their community.
Their reaction was to get as many people as possible inoculated with the measles vaccine, according to Ohio Department of Health officials.
But there are people, called anti-vaxxers, who say the vaccine is potentially more harmful than the disease and chose not to have their children vaccinated. Among them are some people with children with autism.
Paul Garchar, head of the Potential Development Program for Autism in Youngstown, said, however, in his experience that attitude has significantly changed.
“Seven or eight years ago, we had a small group of four or five families who were anti-vaccine,” said Garchar, whose program serves more than 120 families.
“But now, every child in the program, preschool through high school, has a shot record with us,” he said.
A Liberty woman and mother of four unvaccinated children, Sandy Hrabowy, said she is not opposed to vaccinations, but she is opposed to being compelled to have her children vaccinated because she believes there are big risks involved.
Hrabowy said a huge number of people oppose compulsory vaccinations.
She said as a group, “We are educated and do our research. We are not crazy. People in general are woefully uninformed about the risks of vaccinations.”
Regarding herd immunity, she said, “If your child is vaccinated and mine is not, mine should be no threat to yours.
“I truly believe that as we improve our nutrition, our standard of living, sanitation and water, diseases disappear and the death rate comes down,” Hrabowy said.
The concern of public health officials and physicians is that if too many children don’t get vaccinated, so-called herd immunity might be destroyed.
“It’s alarming,” said Mahoning County Health Commissioner Patricia Sweeney.
“Herd immunity is needed to protect children too young to get the vaccine or children and adults whose immune systems are compromised and can’t tolerate the shot,” she said.
To achieve and maintain herd immunity, between 92 and 95 percent of children should receive two doses of the measles, mumps, and rubella (MMR) vaccine, according to the Centers for Disease Control and Prevention.
But in some communities, opt-out rates are soaring either on philosophical grounds or because of a belief that vaccines are dangerous to children, according to the CDC.
Measles is spread by respiratory droplets put into the air when infected people sneeze or cough. The droplets can stay in the environment for up to three hours before they become noncontagious.
“Measles is a serious infection ... a downright bad disease that has the capacity to ramp up and cause problems if there is any exposure at all,” Dr. Venglarcik said.
In addition to fever and rash, measles also can cause severe illness and complications such as diarrhea, ear infections, pneumonia, encephalitis (brain infection), seizures, blindness and death, complications that are more common among children under 5 and adults older than 20, reported the Ohio Department of Health.
The one advantage to the recent outbreaks is that they remind people of the need for vaccinations, Dr. Venglarcik said.
The thing to really stress, said Dr. John Bower, infectious disease specialist with Akron Children’s Hospital, is that measles is dangerous.
Before the measles vaccine became available in 1963, the virus infected about 500,000 Americans a year, causing 500 deaths, 1,000 with brain damage, and 50,000 hospitalizations of adults and children. One or two out of 1,000 children infected with measles will die, says the CDC.
Case counts since 2000 have ranged from 37 in 2004 to a high of 220 in 2011, the CDC reported.
Vaccines, however, have revolutionized health care, Dr. Bower said.
“Vaccines for measles and other diseases is one of the great advances in modern medicine, up there with antibiotics, and it needs to be recognized as such,” he said.
He said, however, the emphasis should not be on assigning blame for the recent outbreak.
“Instead, it should alert us that more public education is needed,” Dr. Bower said.
The furor over the number of cases in the United States is not the issue, he said.
The questions are, he said: Are people who are anti-vaccine going to create enough of a nonvaccinated group to allow a disease such as measles to make a comeback? Are they just potentially hurting themselves and others who have not been immunized? Are they endangering their entire school or community or nation?
Measles is so infectious, that unvaccinated people exposed have a 90 percent chance of infection. It is very similar to chickenpox in that respect, but much more dangerous, Dr. Bowers said.
Children and adults who are medically able should definitely receive the measles vaccine, Dr. Bower said.