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Measles outbreak spreads; no cases so far at AV schools

Cover Design by Andrew Nunez (120102)
Cover Design by Andrew Nunez

Stretching from the streets Disneyland to the steps of Capitol Hill, the measles outbreak and resultant commentary has returned focus to a generations’-old discussion of why and when children should receive vaccinations.

To date, at least 700 Los Angeles County residents have come in contact with someone who has measles, according to the Los Angeles County Department of Public Health, and 35 of those individuals were reportedly unvaccinated. Nineteen have come down with the virus with all but one having come in contact with an infected person who visited Disneyland sometime between Dec. 15 and 20. The California Department of Public Health (CDPH) has reported 93 verified cases statewide and 16 cases in seven other states and Mexico. Statewide, unvaccinated students from some school districts are being told to stay home.

Measles is a highly contagious viral disease that is still widespread in may parts of the world. It begins with a fever that lasts for a couple of days, followed by a cough, runny nose, conjunctivitis (pink eye), and a spotty, itchy red rash. The rash typically appears first on the face—along the hairline and behind the ears—and then affects the rest of the body. Children once routinely received their first dose of the MMR (measles, mumps, rubella) vaccine at 12 months or older, with a second dose usually administered just before the child began kindergarten. Severe complications from the vaccine are rare but can lead to pneumonia, encephalitis (swelling of the brain) and sometimes death. Studies conducted by the Centers for Disease Control and Prevention (CDC) have demonstrated that 99 percent of persons who receive the two doses of measles vaccine will develop an immunity to the disease.

The CDC this week reported 102 cases of measles in 14 states. CDC Director Tom Frieden said the U.S. is “likely to see more cases,” adding that there is “aggressive public health action” to identify those with measles, to isolate the sick and to quarantine those who have been exposed. Frieden said despite the nation’s 92-percent vaccination rate, there is growing evidence that more parents are not vaccinating their children.

“What we’ve seen is, over the last few years, a small but growing number of people have not been vaccinated. That number is building up among young adults in society, and that makes us vulnerable,” Frieden said.

There are no reported cases of measles within the Palmdale School District. “I have been speaking with the county  department of health several times a week,” said Julie Ferebee, health services director for the Palmdale School District. “So far we have no cases. Because of the seriousness of this disease and the speed of infection, we are keeping a very close watch on our students and staff.” Late last week county health officials identified a 23-year-old woman from the Antelope Valley as having contracted measles. None of the remaining seven school districts in the Antelope Valley have reported any students with measles.

New campaign aimed at teens

Orange, Los Angeles and San Diego counties (as of Feb. 3) had the most number of confirmed cases in the state with 28, 21 and 13 respectively. Ventura, San Bernardino, Riverside and Alameda counties this week had reported a combined 24 cases of measles.

Los Angeles County is trying to stay ahead of the recent outbreaks by encouraging families to be more proactive in their healthcare options. The Immunize L.A. Families Coalition will hold its “Pre-teen Vaccine Week” from Feb. 8-14 in hopes of curtailing future cases of measles and other infectious diseases which are commonly believed to be childhood maladies; outbreak levels are reportedly rising among the adult population in the southwest United States. Preteen Vaccine Week is a campaign of the CDPH.

Oliver Brooks, chair of the Immunize L.A. Families Coalition, said the new screening operation is designed to help families avoid serious health scares by learning the facts about immunization.

“Pre-teen vaccines help to prevent significant illness, specifically measles, whooping cough and cervical cancer,” said Brooks, a pediatrician, associate medical director of the Watts HealthCare Coalition and also chief of its Department of Pediatrics and Adolescent Medicine. “The Tdap vaccination is formulated specifically to prevent whooping cough as well as tetanus and diphtheria. The HPV (human papillomavirus) prevents cervical cancer and the warts associated with that disease. These are preventative measures available today to stop the spread of dangerous infectious diseases that we once had a handle on.”

An immunization schedule, Brooks explained, is the most practical way of ensuring that your child does not contract a preventable disease. Today, in most hospitals and medical clinics, it is a “one-stop” visit to receive necessary vaccinations. Brooks suggests that parents and children visit their doctor and get vaccinated “at once.”

An examination of California immunization rates reveals a drop in the number of those being vaccinated. In 1995, the CDPH reported 109 cases of measles statewide. From October 2014 through January 2015, Los Angeles County health officials had recorded 65 cases. In 1998, the California kindergarten immunization rate stood at 96 percent, but that figure had dropped to 91 percent by the beginning of this year. In 1958, the rate of whooping cough infection countywide was 26 per 100,000 residents, eventually dropping to zero in the early 1980s. Since January, the rate has returned to the same number it was 56 years ago.

Fear vs. facts

The latest controversy surrounding measles is not the spread of the disease but, rather, the spotlight focused on some parents or guardians who have opted not to have their children vaccinated. The CDPH in October 2013 made available to parents and guardians a Personal Belief Exemption (PBE) form for their signature stipulating that they will forgo vaccinating their child in face of a new law set forth in January 2014 requiring such shots for children kindergarten through 12th grade (also students advancing to the seventh grade for the first time and children newly admitted to a childcare facility). The new law also allows for a religious exemption, if the family’s belief/faith does not permit members to get medical advice or treatment from a health care practitioner. The CDPH has said that childhood vaccination is “… the best and safest way” to prevent many serious, often deadly diseases in children.

“It is important that parents make an informed decision,” said Dr. Ron Chapman CDPH director and state health officer. “The form made available to parents is designed to encourage education about vaccinations while protecting an individual’s constitutional rights.”

The California Association of Private School Organizations, representing organizations that operate pre-collegiate, independent and religious schools, is urging members to notify their local public health departments if a student is suspected of having measles. According to the CDPH, statewide there is a higher percentage of children at private schools who are less likely to be immunized under the PBE. The Archdiocese of Los Angeles is part of the aforementioned collective of private schools. “Our members have expressed concern, and we are concerned, and we have encouraged our members to have their schools contact public health authorities to obtain information on the best way to deal with parents who have exercised the exemption,” said Ron Reynolds, executive director of the association. “We favor a balance of parental rights and public health safety.”

Brooks concurs with other physicians who say that parents who decline to vaccinate their children are making an unwise decision that could lead to an entirely preventable health crisis. “The rise of people shunning vaccinations is alarming,” Brooks said, “because there is no scientific evidence to suggest this is correct. Bottom line, the unvaccinated will get measles, such as what happened during the Christmas season at Disneyland. There are too many people who have not received the proper vaccination and that is a tragedy because we have—and always have had—the means to prevent such outbreaks. Misinformation is behind the outbreak … not the vaccine.”

Class and community well-being

Now class differences have come into play. For the past  few years it has been widely reported that so-called “wealthy” parents throughout the Southland have decided not to inoculate their children with the Tdap (tetanus, diphtheria, whooping cough), HPV (human papillomavirus), meningococcal, influenza (flu) or chickenpox vaccines for reasons varying from the possibility of poisoning their child, unwittingly encouraging an infection, or even fear of the chance of early onset of Autism Spectrum Disorder.

Nina Shapiro, a professor at UCLA who has been tracking this trend for the past four years, says the anti-vaccine phenomenon is more “en-vogue” among certain classes who believe that not vaccinating is a more reliable method to ward off infectious diseases. Shapiro describes the trend as: “‘I’m going to be pure and I want to keep my child pure,’” she said. “Refusing vaccination has become somewhat of a status symbol, or a way to distinguish your special ‘snowflake’ from the herd. It’s in line with other trends of varied inherent value, such as putting your kid in a private school, not allowing him/her to ever eat trashy ‘kid’ food like hot dogs or macaroni and cheese, or forbidding him/her from engaging with pop culture.”

Last month at Huntington Beach High School in Orange County, more than 20 students without proof of immunization were ordered to stay home for three weeks, after an infected student was identified there.

There is a history of such measures taken by school officials. In 1977, Los Angeles County health officials faced two measles deaths, as well as three cases of brain inflammation and numerous cases of pneumonia requiring hospitalization stemming from measles, according to the journal Vaccine. County officials ordered all children who had no proof of measles immunity to get the shot or be banned from school. About 50,000 students were ultimately told to stay away from campus. Within days, most of the youth were back in school with proof of immunity and the number of measles cases had “dropped precipitously,” the report stated. Health experts in Orange County said last month that it is  “a problem” when eight percent or more of parents have declined vaccines that keep diseases such as measles from spreading.

Within the more “upscale” Huntington Beach City School District, the Orange County Health Care Agency reported last month that two out of seven kindergarten classes exceed the “eight percent” figure; one grade school, S.A. Moffett Elementary, has 10 percent of its children exempted from vaccines, while at nearby Huntington Seacliff Elementary, 11 percent of children there are not vaccinated. The rate was 9.5 percent of kindergartners in the Capistrano Unified School District and, a little closer to home, 14.8 percent of students enrolled in the Santa Monica-Malibu Unified School District are exempt from inoculation.

Politicians chime in

This week New Jersey Gov. Chris Christie said parents should have “some measure of choice” when it comes to vaccinating children, adding that he and his wife have had their children vaccinated. “We think that is an important part of being sure we protect their health and the public health,” said the presidential hopeful. “But I also understand that parents need to have some measure of choice in things as well, so that’s the balance . . . the government has to decide.”

Kentucky Sen. Rand Paul this week said he has heard of cases where vaccines have led to “mental disorders.” Paul, a ophthalmologist by trade, also said federal mandatory vaccines could be akin to martial law. “I’ve heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines,” Paul said. After suggesting that vaccines be voluntary, Paul posted a photo of himself receiving a measles booster shot.

Former Secretary of State Hillary Clinton weighed in on Twitter: “The science is clear: The earth is round, the sky is blue and vaccines work. Let’s protect our kids.”

Modern law on vaccinations can be traced back to a 1905 court case, Jacobson v. Massachusetts, in which the state fined a preacher who refused to get a small pox vaccination. The preacher sued all the way to the U.S. Supreme Court which ruled that Massachusetts, like all states, had expansive “police powers” to protect the health and safety of its citizens. Requiring vaccinations, the Court ruled, was well within the limits of that power.