Colorado at high risk for measles outbreak
March 12, 2019
It’s a scary experience for any parent: wiping tears and quieting screams from babies and toddlers who have been pricked — often with more than one needle per visit — at the pediatrician’s office, then spending a day or two with a fussy, feverish little one who is uncomfortable and out of sorts.
Then, there’s the fear there could be something in the vaccine that could cause harm to the child.
While there is a lot of good information out there, the descent into the Google wormhole of “vaccine side effects” can be a perilous one. Proponents point to millions of lives saved by vaccines and contend they are safe, with very rare adverse reactions. Opponents argue that children's immune systems can fight most infections naturally, and vaccines can cause a number of side effects, including death.
But the recent outbreak of measles in the northwestern United States, which maps to areas with lower vaccination rates, serves as a reminder that vaccines are effective and future outbreaks are likely.
Julie Alkema, Colorado Northwestern Community College nursing faculty, said she believes most parents want to do the right thing but have been misinformed about the risks and benefits.
At Pediatrics of Steamboat Springs, Dr. Ron Famiglietti agrees parents are only trying to protect their children, and at the end of the day, it is up to parents to make their own decisions.
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But, “We wouldn’t recommend it if it weren’t safe,” Famiglietti said, of the measles, mumps, and rubella — or MMR — vaccine, and the vaccine schedule as a whole. “We like kids. We wouldn’t tell parents to do it if it here harmful.”
Famiglietti often tells parents that, as mothers and fathers themselves, he and the other doctors and nurses in his office all follow the vaccination schedule for their children — decisions based on the best scientific evidence available.
As outbreaks of measles grow across the nation and the globe, there is a very real concern the disease is making a comeback.
From Jan. 1 to Feb. 28, 206 individual cases of measles were confirmed in 11 states, including one in Colorado, according to the Centers for Disease Control.
And Colorado is at a higher risk than any other state for an outbreak, according to a state-by-state survey by the CDC showing the percentage of kindergarteners vaccinated for MMR in 2017-18.
With an 88.7 percent vaccination rate, Colorado is ranked at the bottom of the list. Wyoming was the only state not surveyed.
Colorado is also one of the easiest states in which to get an exemption, according to the CDC survey; it is also the state in which more parents claim exemptions than any other state tracked.
There are 17 states that allow personal belief or philosophical exemptions for vaccinations. The vast majority of MMR exemptions in the state — and in Moffat and Routt counties — are for personal beliefs as opposed to religious or medical reasons.
However, Colorado Rep. Kyle Mullica is currently working to pass a bill that would eliminate nonmedical exemptions for vaccines.
And just this week, the Washington State House of Representatives passed a bill ending personal or philosophical exemptions for the MMR vaccine. It will now go before the state senate, which is proposing its own broader bill.
The MMR vaccination rate in Clark County, Washington, the outbreak's epicenter, was 78 percent for school-aged children.
That leaves unvaccinated about 40 school-age students and five kindergartners in Moffat County, as well as a significant number of Routt County students — more than 200 in the county's three school districts — and it doesn’t mean the region is safe from an outbreak, especially with the large percentage of residents who travel and the tourists who visit.
The MMR vaccine is 97-percent effective, according to the CDC. Thus, while unusual, vaccinated people can still get measles. To protect the entire population — to achieve the “herd immunity” effect — 95 percent of the population must be vaccinated. While Moffat County’s average is higher than 95 percent for both age classes, the public schools reported numbers ranging from a low of 76.67 percent to a high of 100 percent, with most below 95 percent.
Any vaccine carries risks. Some of those, while more rare, can be serious. And, as with anything, the risks must be weighed.
In 1990, the CDC and Food and Drug Administration created the Vaccine Adverse Event Reporting System. Of the approximate 30,000 reports received each year, 85 to 90 percent of are for "mild adverse events, such as fever, local reactions (such as redness at the injection site), and episodes of crying or mild irritability." The other 10 to 15 percent of reports are for "serious adverse events involving life-threatening conditions, hospitalization, permanent disability, or death, which may or may not have been caused by a vaccine."
There are potential side effects of the MMR vaccine, most commonly, a low-grade fever, headaches and muscle aches, and redness or soreness around the injection site, said Dr. Steven Ross, of Sleeping Bear Pediatrics.
Some of those side effect, however — while rare — can be serious, and the risks must be weighed, as with anything else: driving on icy roads, living near a power plant, or smoking.
But the risks associated with measles are far greater than the vaccine's risks, Famiglietti said.
Measles is “not just a cold with spots,” he said. “It’s an illness people die from.”
Globally, measles infections were responsible for 110,000 deaths in 2017. Most of them were children younger than 5.
Before vaccines began being widely distributed in the 1960s, there were millions of measles deaths each year across the globe. In the U.S. alone, there were 400 to 500 measles deaths per year.
Measles remains a leading cause of vaccine-preventable infant mortality, according to the CDC. From 2000 to 2016, it is estimated that 20.4 million measles deaths were prevented globally by the vaccine.
One in 10 people who get measles also contract ear infections that can lead to deafness. One in 20 develop pneumonia, and one in 1,000 are stricken with encephalitis — an inflammation of the brain.
One or two per 1,000 individuals who get measles die from it.
“Measles is especially virulent,” Alkema said.
It’s also incredibly contagious, Famiglietti noted. About 90 percent of people who come into contact with the disease will contract it.
Measles is most dangerous to the most vulnerable people — elderly people, infants younger than 1 year old (children typically receive their first MMR vaccine around 12 to 15 months of age), those with weakened immune systems, and those who cannot be vaccinated for medical reasons.
Much of the controversy surrounding the MMR vaccine comes from a since retracted 1998 article by Andrew Wakefield, which suggested a link to autism.
The association between the MMR vaccine and autism has been completely disproven.
In 2011, Wakefield was stripped of his medical license. Earlier that year, the British Journal of Medicine published an article detailing money Wakefield received from lawyers and evidence his original research was falsified.
Another controversial ingredient, thimerosal, has been removed from children's vaccines.
But vaccines remain a sensitive issue with a lot of passion from all sides.
Famiglietti takes a compassionate approach toward families. Parents are concerned they may be causing harm to their child, he said, and they "aren't trying to be mean to the rest of the population."
While respecting the wishes of the parents, his office strongly recommends they follow the vaccine schedule.
At Sleeping Bear Pediatrics, Dr. Steven Ross also understands how frightening it can be as a parent, especially with an inundation of information and misinformation to sort through. Ross works to arm parents with the best available information. One of the first resources on measles he gives out is the "Children's Hospital Colorado's 10 Things Parents Should Know About Measles."
The concern of measles making a comeback is a real one, Ross said, pointing to Europe.
Measles cases in Europe tripled between 2017 and 2018, according to data from the World Health Organization.
There were 72 deaths from measles in Europe in 2018, compared to 42 in 2017.
Much of that is attributed to the fact MMR vaccination rates in Ukraine fell sharply over a number of years during its conflict with Russia. Reaching 31 percent in 2016, its rate was among the lowest in the world.
And those increased rates of measles and decrease in vaccination rates can take a decade to get back under control, Ross said.
Ross has countless websites and articles from reputable institutions he’s ready to give out.
“We really do care about children in Routt County,” he said. “We are not part of some black-ops cover-up for vaccines.”
He pointed to a March 5 New York Times article, saying a "new large study published this week found no association between the measles vaccine and autism."
And in terms of the youngest, oldest, and most vulnerable people who may be at the highest risk in the event of an outbreak, “We are really looking at the whole community,” Ross said.
“We do respect the wishes of parents,” Ross added. “And we try to give out the best information.”
With evidence-based, high-quality resources, and “patience and perseverance,” Ross said, he hopes to help parents make their own best decisions to protect their children — and the community.
Contact Kari Dequine Harden at 970-871-4205 or kharden@SteamboatPilot.com, or follow her on Twitter @KariHarden. Sasha Nelson contributed this report. Contact Nelson at 970-875-1794 or snelson@CraigDailyPress.com.