On the front line of a public health disaster
My colleagues who practice in nearby Clark County, Washington, are on the front line of an outbreak right now. There have been 73 confirmed cases of measles in the county so far this year, 67 of which were in children. This has led to community-wide, coordinated disease control efforts.
All the staff in Clark County clinics quickly learned how to ask about the symptoms of measles and to direct families to hospital emergency departments with negative pressure rooms. These specially designed facilities take air up and out of the facility rather than spreading it to other patients. It’s a critical infection control measure since the measles virus can remain circulating in the air 2 hours after the infected child leaves a room, and 95% of unvaccinated people exposed to measles will contract it. At hospitals in Clark County, even security guards manning the doors have learned to triage patients and to advise healthy, but unvaccinated, persons not to enter.
Outside of Clark County, practices in the state continue to handle hundreds of calls from frightened parents. They want to know how to protect infants still
too young to get the MMR vaccine, and children with compromised immune systems due to cancer therapy or genetic disorders.
We have all brushed up on our knowledge about the disease and the vaccine to best counsel families.
"Based on community vaccination rates, you can almost predict where outbreaks will occur. In Washington state, 80% of schools are below the 95% MMR immunization rate needed to achieve community immunity. Within Clark County, the site of our measles outbreak, just 78% of kids enrolled in school received all recommended vaccines. Several schools in the county have rates under 50%.”
Limiting non-medical vaccine exemptions
Beyond advising parents, we are demanding action from our
state legislature. Washington is one of 17 states that allows children to be
exempt from vaccines required for school entry due to personal and
philosophical beliefs. As a result, the
rate of children entering kindergarten with vaccine exemptions is about twice
the national average.
House Bill 1638 would eliminate personal and philosophical
exemptions for the MMR vaccine, required for school entry, to protect the most
vulnerable around us. Another bill before our legislature, Senate Bill 5841,
would eliminate personal and philosophical exemptions for all vaccines required
for school. California ended personal
belief vaccine exemptions for children in public and private schools after a 2015measles outbreak traced back to Disneyland made nearly 150 sick and spread
across the United States and Canada. Vermont also ended personal (but not
religious) exemptions that year.
Based on community vaccination rates, you can almost predict
where outbreaks will occur. In
Washington state, 80% of schools are below the 95% MMR immunization rate needed
to achieve community
immunity. Within Clark County, the
site of our measles outbreak, just 78% of kids enrolled in school received all
recommended vaccines. Several schools in the county have rates under 50%.
Working to dispel vaccine myths & misinformation
Even with the outbreak, this legislative ask is a heavy lift. Our legislators are being fed piles of
misinformation about the safety of vaccines.
We find ourselves needing to dispel many myths and convince our
legislators to stand with facts over fiction.
I have testified to our state legislature on several bills related
to child health this session, but the hearing on immunization exemption bill
was a new experience. I was escorted by
security through crowds that lined up hours in advance. Everyone on the panel speaking in favor of
the bill were local advocates. The panel
speaking opposed were “experts” flown in from other states to “educate” our
legislature on the “dangers” of vaccines. They were bolstered by vaccine hesitant parents who want what is best
for their kids, but unfortunately believe the misinformation these “experts”
The World Health Organization now considers vaccine
hesitancy to be one of the top ten threats to global health. In Europe, where vaccine hesitancy based on misinformation
also has spread, 72 children and adults died from measles in 2017.
As we continue to engage every day with parents whose vaccine
hesitancy comes from a place of caring, we must also continue to drown out and
dispel the misinformation bombarded at parents and decision makers by fiercely
advocating for our kids.
Since the start of our state’s measles outbreak, the rate of
MMR immunization rate in Clark County has increased 500%. Public health wins can rise from public
health disasters. Our communities need us
pediatricians to sound the alarm.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Rupin Thakkar, MD, FAAP, is President of the
Washington Chapter of the American Academy of Pediatrics and serves on AAP’s
Councils on Community Pediatrics and Communications and Media. Dr. Thakkar is Medical
Director of Swedish Pediatrics - Edmonds, a primary care clinic located in
Edmonds, Washington, that is part of Swedish Health Services based in Seattle,
Washington. He is also Assistant
Clinical Professor at the University of Washington School of Medicine.