AAP Voices Blog

With measles outbreaks taking hold across the country, and a state of emergency declared here in Washington state, my office fields multiple calls a day from worried parents. Many have infants and are afraid to leave their homes. I’ve also spoke to a mother terrified to take her toddler son, currently undergoing chemotherapy, to his appointments.

As pediatricians, we are doing our best to give parents information they need to help keep their children safe. We’re also pushing our state legislators to address one of the core reasons the outbreaks in our state and elsewhere are happening: laws governing immunization exemptions based on personal and philosophical beliefs, without any medical need, that increasingly imperil public health.

Twelve years into my pediatric practice, I am thankful that I have not yet seen a child with measles. Pediatricians senior to me, who recall seeing multiple cases before the virus had been considered eliminated from the United States in 2000, share how scary the disease can be. They describe treating children whose measles led to pneumonia, deafness, brain damage and even death, and what an incredible triumph of science the Measles, Mumps & Rubella (MMR) vaccine has been.

Because of widespread misinformation about the MMR vaccine, however, immunization rates have dropped precipitously—a situation fueling the current outbreaks. Unless we reverse the tide, pediatricians of my generation will unfortunately become adept at diagnosing measles and have horror stories of their own to tell.

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 2015 measles 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” have spread.

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.