measles

RECENT POSTS

Elmo’s New Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines

 

Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on “Sesame Street,” no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

What’s The Vaccination Rate At Our School? Mass. Parents Can Now Look It Up

CLICK TO ENLARGE: A sample from the Massachusetts Department of Public Health's compilation of school immunization rates, recently made public

CLICK TO ENLARGE: A sample from the Massachusetts Department of Public Health’s compilation of school immunization rates, recently made public

Amid the current Disneyland-vector measles outbreak and the new spotlight it’s putting on vaccine gaps, many a parent is wondering: What’s the vaccination rate at my own child’s school? What are the chances that my kid will come into contact with an unvaccinated kid? And does our school make the cut-off for “herd immunity,” that desirable state when so many people are vaccinated that even if a bug gets in, it’s unlikely to spread?

USA Today has published a beautifully granular look-up tool of vaccination rates broken down by school, with data for 13 states, including Massachusetts. Its interface lets you look up a specific school by typing in its name.

But we in Massachusetts are particularly data-rich, in that the state Department of Public Health has just recently posted a spreadsheet of all our schools, grouped together by town; that means we can not only check a particular school’s rate but also compare it with its neighbors’.

The full state list of schools and their kindergarten vaccination rates is here, in an easy format that looks like the spreadsheet shown above.

So what are we to make of these numbers, particularly if our own school’s rate looks low?

I spoke with Pejman Talebian, chief of the immunization service at the state’s Department of Public Health. My biggest takeaway: If your school’s numbers look low, don’t freak out. It could be an artifact of under-reporting, particularly if the numbers of vaccine exemptions are low. But there are, he said, pockets of concern, particularly on Cape Cod and in western Massachusetts, where the numbers of exemptions tend to be high and vaccination rates lower than desired.

Our conversation, lightly edited:

What would you hope that parents and school communities do with this data?

We hope that it starts conversations around immunization. And we hope that in areas of the state where there are lower rates, and higher rates of exemptions, it prompts more conversations between health care providers in those communities, local health officials in those communities, and the community as a whole — that they talk about the benefits of immunization, prompting folks to potentially reconsider their stance around immunization. Hopefully, it will lead to more individuals seeking to be fully vaccinated.

“These pockets are not in lower-income city areas, they generally tend to be in middle and upper middle class communities.”

– Pejman Talebian,
state Department of Public Health

Is there anything that communities should be sure not to do?

I wouldn’t take one data point around one specific school and assume there’s definitely a concern or definitely a problem. This is all self-reported information and some of it may not be a true reflection of what is the actual immunization coverage in the school. So if you do see a school with what appears to be very low immunization rates, that doesn’t mean that that school is definitely ripe for an outbreak tomorrow and that’s a major concern. It should just prompt questions and conversations with school health staff and with the community, ensuring the population is being properly vaccinated.

How long have we had this data? When did it go public? Continue reading

One Doctor Asks: Why Are We Arguing About Measles Vaccines In 2015?

By Dr. Rebecca Weintraub
Guest Contributor

This week, as I juggled work, family and shoveling, I prepared a lecture on promoting equity in health delivery. My first slide is a picture of the Ebola virus, and as of this morning, my last slide is a map of the ongoing measles outbreak. That’s because this week, we’ve heard a clear public health message from both President Obama and Surgeon General Vivek Murthy: Vaccines are safe and effective.

Why is this message being repeated in 2015?

As a mother and physician, I am dismayed that all Americans are not practicing this guidance based on evidence from 40 years ago. Vaccines are safe and effective. There is no link between vaccines and autism.

In 1757, Dr. Francis Home proved the infectious nature of measles and detected the virus in blood. The highly contagious virus spreads via droplets and replicates within the newly infected person for 14 days. The symptoms include high fever, red eyes, runny nose and cough. A few days after the onset of these symptoms, “Koplick’s” spots—bluish markings on the inside of the cheek—appear. Then, a rash starts at the head and travels to the feet. The infected person is contagious for four days before and after the onset of the rash. We test suspected cases for antibodies against the virus. After confirmation, the treatment is supportive, including rehydration, nutritional support, medicines to reduce fever, antibiotics for superimposed infections, and Vitamin A supplementation. Once the measles infection has taken hold, there is no cure.

We’ve made tremendous strides in the discovery and development of new vaccines. In 2000, the Centers for Disease Control and Prevention declared the measles virus eliminated. But now, there are over 100 confirmed cases of measles across 14 states. Our most vulnerable populations are at risk of contracting an entirely preventable disease. This is not only an issue of choice, but an issue of health equity and our role as global citizens.

So now we can, and must, eradicate measles… again. We can learn from Mississippi and West Virginia, which have been at the forefront of new vaccination efforts. Continue reading

Why The Current, Post-Eradication Measles Outbreak Is So Infuriating

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

That certain parents refuse to get their kids vaccinated isn’t new. But suddenly, it’s news. And it’s troubling. I’m a big supporter of “crunchy” parenting, but not when it puts other people’s children (and mine) at risk. The current measles outbreak has infuriated many parents and medical professionals who, fuming, wonder why we are arguing about a virus that was already eliminated here in the U.S. 15 years ago.

So, here’s one such parental rant on the topic by Alicair Peltonen, an administrative assistant at the Harvard School of Public Health and a journalism student at the Harvard Extension School.

By Alicair Peltonen
Guest Contributor

When I was in elementary school, one of my favorite books was called “The Value of Believing In Yourself,” by Spencer Johnson, MD. It was part of a children’s book series meant to teach lessons through the life stories of historical figures. The Value of Believing In Yourself was about Louis Pasteur and his quest to develop the rabies vaccine.

That book still stands as my most cherished source for the science of immunity. Even with a bachelor’s degree in biology, a career spent working in scientific and medical research and a current job in the immunology department of a prestigious graduate school, I still picture all viruses as scruffy black blobs with scary pink faces and foaming fangs. And vaccines are the steadfast soldiers in uniform with huge mustaches and bayonets that are sent in to get the bad guys. How on earth could anyone be more scared of the soldiers than the black blobs?

I have kids. I know all about fear. Those first days with my oldest daughter were magic, but it was a dark magic. It came with visions of this tiny creature I was now in charge of falling off my lap as I breast-fed or rolling face-first into a crib bumper. I imagined a hundred ways she could be injured or worse — and I imagined all the ways it would be my fault.

I went straight to my local Isis Maternity (a wonderful organization that no longer exists) and signed up for new mommy classes. Those classes were an education for me, not in what to do as a new parent, but what not to do. All the women I sat criss-cross applesauce with were lovely, caring, engaged moms who were genuinely searching for the best way to rear happy, healthy child. And every single one of them was irrationally afraid of one thing. And those “things” were all different. Continue reading

How To Talk To Parents Who Oppose Measles Vaccines? We Don’t Know

In this Jan. 29 photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The measles outbreak that originated at Disneyland in December has prompted politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (Damian Dovarganes/AP)

In this Jan. 29 photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The measles outbreak that originated at Disneyland in December has prompted politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (Damian Dovarganes/AP)

Suddenly, measles is political. The Disneyland outbreak has turned the long-simmering issue of parents who decline vaccinations for their kids into a political hot potato, to the point that the New York Times just did a round-up of where potential presidential candidates stand on vaccination. (Classic Hillary Rodham Clinton tweet: “The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids.”)

My thought: Great. The topic is already rife with fear and anger and parental conflict, and now we’re adding politics? And I wondered: Is there, in fact, a known way to discuss vaccine resistance constructively? When a pediatrician faces a hesitant parent, or when I encounter a parent in my community who fails to get a child vaccinated?

I asked Dr. Barry Bloom, an infectious diseases expert at the Harvard School of Public Health, who co-authored an editorial in the journal Science — “Addressing Vaccine Hesitancy” — and was also recently featured here: “Talking The Talk On Vaccines.” His reply:

One of the amazing things is that we don’t know the answer to your question. I chaired a meeting at the American Academy of Arts and Sciences on the subject of trust in vaccines. We brought in lots of people — from state governments, doctors — to find the answer to your question: What do we know about how to persuade people that it is in kids’ best interest to protect them against diseases they’ve never seen?

My take is that the answer is two-fold:

One, not everyone is the same. There are a myriad of reasons that people give when questioned about why they don’t vaccinate kids, or delay vaccinations. So there’s no one-size answer that will fit all.

The vast majority of people listen to their doctors — they’re very important — and they do what is recommended because they believe doctors wouldn’t want to harm their kid.

Then there’s a very small group of people who, for a variety of ideological, certainly not scientific, reasons, are opposed in any manner, shape or form to being told what to do, to having government make requirements for school entry, and so on.

The third part of that is people who are responding to discredited publications claiming that vaccines cause bad things to happen. I have to say when I saw one of the physicians in Congress, Rand Paul, say that he had heard vaccines cause neurological or psychological damage, I was absolutely stunned, because there’s no data to support that whatsoever. Continue reading

CDC: Record-Breaking Year For Measles Due To Travel, Non-Vaccinated Residents

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Measles, one of the most contagious diseases in the world, was officially eliminated from the U.S. in the year 2000.

Nevertheless, we’re in the midst of a record-breaking year for measles in this country, according to a new report from the Centers for Disease Control and Prevention, with 288 confirmed cases so far.

There are two main reasons for the spike, said Anne Schuchat, M.D. (RADM, USPHS) assistant surgeon general, United States Public Health Service and director of the CDC’s National Center for Immunization and Respiratory Diseases, speaking at a telebriefing for reporters today.

First, she said, travelers are importing measles into the U.S. from other parts of the world, including Europe, Asia, Africa and the Pacific, notably the Philippines, which has been experiencing a large measles outbreak. In addition, Schuchat said, the imported measles is spreading within communities of non-vaccinated people.

CDC: It's a record-breaking year for measles

CDC: It’s a record-breaking year for measles

From the agency’s weekly Morbidity and Mortality Report:

Most of the 288 measles cases reported this year have been in persons who were unvaccinated (69%) or who had an unknown vaccination status (20%); 30 (10%) were in persons who were vaccinated. Among the 195 U.S. residents who had measles and were unvaccinated, 165 (85%) declined vaccination because of religious, philosophical, or personal objections, 11 (6%) were missed opportunities for vaccination, and 10 (5%) were too young to receive vaccination.

When asked if the non-vaccinated U.S. residents who contracted measles had declined shots due to widely discredited information linking autism to the MMR vaccine, Schuchat said no, public health officials don’t believe that to be true.

Her bottom line message was clear, however: “This year we are breaking records for measles,” Schuchat said. “And it’s a wake up call. Measles may be forgotten but it’s not gone.” Continue reading

The Good News, Bad News Story On Measles

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

By Alexandra Morris
CommonHealth Intern

Lately, when you hear about measles in the news, the reports tend to be grim: outbreaks in 2011 and 2013 in the U.S., parents who are choosing not to vaccinate their children for religious or philosophical reasons. But a new report from the CDC this week paints a bigger – and far more heartening – picture: from 2000 to 2012, 13.8 million deaths were prevented through measles immunizations globally. In other words, a population roughly the size of New England is still alive thanks to the measles vaccine.

Deaths from measles have dropped 78% since 2000. “These figures represent historic lows for estimated measles deaths globally,” said James Goodson, a co-author of the CDC report published in this week’s Morbidity and Mortality Weekly Report.

Since 2000, the Measles and Rubella Initiative – a partnership between various agencies including the CDC and the World Health Organization – has provided over a billion doses of measles vaccinations worldwide.

Measles was eliminated in the U.S. in 2000, but there have been a couple of recent spikes in cases. Just last year, there were three times as many measles infections in the U.S. than in previous years. In raw numbers, that translates to 189 cases, according to the CDC. While that doesn’t seem like a lot, such a highly contagious disease can spread rapidly, especially among people who haven’t been vaccinated.

Countries around the world are also aiming to eliminate measles by 2020 or earlier. Europe, for example, set a goal of measles elimination by 2015. But it doesn’t look like they’re on track to meet that goal, said Goodson. That may be due in part to parents’ fears about the possibility of vaccine side effects.

In 1998, a British medical journal issued a report suggesting the measles vaccine was linked to autism cases, which led to a sharp decline in vaccinations. Although the report was discredited, and later retracted by the journal, parent and anti-vaccine groups continue to fight against routine immunizations.

Misinformation is a major threat to vaccine efforts, say public health officials. Continue reading

Measles Exposure At New England Aquarium, 5/19 & 5/22


This just in overnight:

BOSTON — The Boston Public Health Commission today reported that a volunteer at the New England Aquarium has been diagnosed with measles. The 17 year-old Vermont resident volunteered while contagious on May 19 and May 22, 2011. The Commission’s Infectious Disease Bureau advises that anyone who was at the Aquarium’s main building after 12 noon on May 19 or May 22 may have been exposed to measles.

Measles is an airborne virus that is spread person to person through the air. People are considered immune to measles if they have had two doses of measles-containing vaccine (MMR) or have had a blood test showing that they are immune to measles. People born in the United States before 1957 are likely to be immune to measles. If people do not know their immune status, they should try to locate immunization records and monitor themselves for symptoms. If individuals were at the Aquarium’s main building on May 19 or May 22 and they do not know if they are immune to measles, they are advised to refrain from public activity until 21 days after the exposure.

Symptoms usually begin 10 to 12 days after exposure to a person with measles, but can be delayed for as long as 18 days. Early symptoms include a high fever, runny nose, cough, and red, watery eyes. A skin rash usually occurs two to four days later and begins on the face but soon spreads to other parts of the body. If a person thinks they have symptoms of measles, they should telephone their health care provider.

CDC Issues Travel Alert As Measles Cases Rise

CDC: It's the biggest outbreak of measles in 15 years in the U.S.

As you listen to Carey on Radio Boston today talking about why some pediatricians are dropping patients who won’t vaccinate their children, here’s some context:

The CDC is now warning that an outbreak of new measles cases is posing a travel risk, particularly for the very young.

USA Today reports:

Babies and children too young to be fully vaccinated are particularly vulnerable, says Gregory Wallace, a measles expert at the CDC. So are the children of parents who choose not to give them shots. Concern for the youngest travelers has led CDC to issue an alert to families planning to go abroad. Although babies typically don’t get their first measles shot until they’re 1 year old, the CDC now says that babies who will be traveling abroad can be vaccinated as early as 6 months.
About 15% of the patients diagnosed with measles this year were under 1 year old, the CDC says. More than half of the children under age 5 with measles have been hospitalized. The largest outbreak in the USA this year has been in Minnesota, affecting 21 people — including seven babies too young to be vaccinated — in a community where parents turned down vaccinations because of concerns about vaccine safety, the CDC says.

It’s the largest outbreak in 15 years, the report says, of “a disease that was declared eliminated in the USA in 2000.”

Doctors have reported 118 measles cases in the USA since January — nearly twice as many as the total for all of last year, according to a report released Tuesday by the Centers for Disease Control and Prevention. About 90% were unvaccinated, and 40% of patients had to be hospitalized for complications. Most of the patients brought the disease with them from Europe, which is in the throes of a major epidemic, with more than 10,000 cases and six deaths in France alone, according to the CDC. Thousands of additional measles cases have been reported across Europe.

Q&A: With More Measles Reported, What Should Adults Do?

(To keep tabs on the latest local reports of measles cases in real-time, you can click on the Massachusetts Health Alerts box in the lower right portion of this page.)

This week, Massachusetts public health authorities confirmed six new cases of measles. That brings the total number of cases of the highly contagious disease up to 11 for the year. We all know that our children should be vaccinated against measles, but what about adults? Do we need boosters of some sort? How much risk are we at, and how much effort should we expend to protect ourselves at this point?

Dr. Ben Kruskal

I spoke this morning with Dr. Ben Kruskal, director of infection control at Harvard Vanguard Medical Associates and an expert on vaccines.

Q: So what should grown-ups be doing about measles?

A: We’re not quite at the point yet of an all-out effort for adults or kids. But what I would say for adults is that the most important thing — and unfortunately, not an easy thing — is to ascertain if they are immune.

For most of us who’ve grown up in the US, if you were born before 1957, you’re generally presumed to be immune because measles was circulating so much back then that just about everybody got it. And once you’ve had it, you’re immune.

For people born after 1957 who’ve grown up and gone to school in the US, the vast majority have been vaccinated because of school requirements.

For people who haven’t grown up in the US, they should make sure they’ve had two doses of measles-containing vaccine (MMR or just measles vaccine).

For people who don’t have a definite history of their vaccinations, there’s a simple blood test that can be done to demonstrate whether they’re immune. Insurance generally covers the test, and clinicians can generally order it without an office visit. If the blood test is ever positive, immunity is lifelong—the test need not be repeated.

One footnote: From 1963-1967, there was a “killed virus” vaccine used in the US and some parts of the world that was not very effective. People who were immunized with that vaccine may benefit from the blood test.

You can get measles by walking through a room where someone who has it was present an hour earlier.

Q: Would you recommend going to the effort of the blood test mainly for people at particular health risk?

I don’t think the magnitude of the outbreak is big enough to do it for everybody.

On the other hand, measles is so contagious, and a bad enough thing to get, that I don’t think it’s easy to focus on a subgroup that’s at high risk. Measles is probably the single most contagious infection. You can get measles by walking through a room where someone who has it was present an hour earlier. Continue reading