Close Close

Life Health > Health Insurance

Measles threatens U.S. comeback years after elimination

Your article was successfully shared with the contacts you provided.

(Bloomberg) — Measles could once again become native in the U.S., disease experts worry, as an outbreak in California linked to Disneyland has put a spotlight on a growing failure to vaccinate that’s helping the disease to spread.

See also: What the anti-vaccine movement means for insurers.

While 94 percent of California kindergarteners were fully inoculated against the virus last school year, according to the U.S. Centers for Disease Control and Prevention (CDC), there are clusters where vaccination is much lower. In some pockets of California, as much as a quarter of children are undervaccinated — putting them at risk of both contracting the disease and becoming a nexus of future spread.

“Children die as a result of this disease,” said Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minnesota, and director of the Mayo Vaccine Research Group. “In 1990, 3 of every 1,000 children who got measles died from it. That wasn’t the dark ages. We don’t have an effective treatment for measles. The only thing we have is prevention.”

Coverage for measles vaccinations is part of the Patient Protection and Affordable Care Act (PPACA) basic preventive services package. All people with non-grandfathered major medical coverage are supposed to be able to get measles vaccinations without having to pay a co-payment, a deductible or other cost-sharing amounts.

See also: Consumer groups see PPACA preventive services problems.

The measles virus is one of the most contagious pathogens known to man, and causes more serious complications in about three of 10 patients, according to the CDC. It was declared eliminated in the U.S. in 2000, and outbreaks are instead started by people visiting from outside the U.S. or who return and bring it back.

Re-establishing transmission would mean there is sustained chain of infection among U.S. citizens and the disease can no longer be considered eliminated. The CDC warned in 2012 that without high vaccination rates, measles could return.

‘Biggest fear’

“What’s sad is seeing a disease that is so preventable causing all these problems,” said Walter Orenstein, associate director of the Emory Vaccine Center at Emory University in Atlanta. “My biggest fear is we will re-establish transmission and have many more cases.”

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said measles re-establishing itself is less likely than the U.S. developing more frequent outbreaks from imported cases.

“You have parents who don’t allow their children to be vaccinated, and they’re clustered in certain areas,” Fauci said in an interview. The parents reinforce their philosophy of not wanting to get the kids vaccinated. So you have a cadre of kids who aren’t vaccinated and someone comes in from a foreign country that does have endemic measles, and you get outbreaks.’’

See also: PPACA: Use of Preventive Care May Grow.

Fourteen years after the U.K. declared measles eliminated, it once again became endemic in 2008 after a decade of low measles, mumps and rubella vaccination rates, according to the scientific journal Eurosurveillance.

Vulnerable pockets

A Kaiser Permanente study of 154,424 children in Northern California released this month found five geographic pockets where children were significantly more likely to be underimmunized by their third birthday. Almost 1 in 4 toddlers in part of Vallejo, a city in the San Francisco Bay area, are underimmunized, according to the study published in Pediatrics.

Disneyland and nearby Disney California Adventure Park are in Anaheim in Southern California. The current outbreak has sickened 68 in the state, including 48 directly linked to the theme park. Half of those are age 20 or older and most weren’t vaccinated, according to the California Department of Public Health.

While there have been a few hundred cases at most documented in the U.S. each year since 2000, 2014 saw a sharp increase to 644 cases representing 23 outbreaks, the CDC said.

The largest outbreak last year occurred among non-vaccinated Amish communities in Ohio where 382 people caught measles. California took the runner-up title with 60 residents falling sick in just the first five months of the year.

Highly contagious

The virus is highly contagious, spread through the air by coughing and sneezing. It is also insidious, with patients become infectious four days before the telltale rash appears.

The first vaccine became available in 1963, with the current combination shot approved in 1971. A single injection is 93 percent effective, rising to 97 percent for those who get both doses.

While the poor have long had lower rates of vaccination because of the cost, the number of unvaccinated children in other communities who don’t get their shots is growing because of worries vaccines are linked to autism. Doctors have debunked any such link.

“People forget that this is the most contagious human disease,” said Mayo’s Poland. “It’s actually the second most contagious. Fear and ignorance are first.”

Measles complications

While most people with measles suffer from a fever, rash and a cough, it can cause pneumonia, hepatitis, swelling in the brain, blindness and, rarely, death.

“In some sense the success of our immunization program is its own enemy,” Emory’s Orenstein said. “We have a generation of parents not growing up fearing these diseases.”

Orenstein is also chairman of the National Vaccine Advisory Committee, which advises the U.S. Department of Health and Human Services on the National Vaccine Program.

The committee will meet Feb. 10-11 in Washington and plans to talk, in part, about yet-to-be-released draft recommendations from a subgroup of members on how to increase vaccine acceptance.

The Patient-Centered Outcomes Research Institute (PCORI), created under PPACA, is funding research on better ways to communicate with unwilling parents about vaccines.

“We need to figure out how to better meet parents’ needs,” said Tracy Lieu, a pediatrician and director of the Kaiser Permanente Division of Research. “Maybe when we find these clusters we can better respond.”