Vaccines successfully rendered measles obsolete. A widespread, contagious and sometimes serious disease disappeared to the extent that many forgot it existed.
Except it came back. And not for nostalgic reasons. The Centers for Disease Control and Prevention (CDC) report 1,241 cases of measles since the beginning of the year. That’s up from 372 in 2018 and 120 in 2017.
In this case, the resurgence involved almost exclusively people who have not been vaccinated.
Because it can be connected to apprehensiveness toward vaccinations, it places caregivers on the front lines. Combating misinformation is a new role for doctors. Educating patients, many of whom have questions about vaccines for measles and other contagious diseases, is vital.
Ultimately, the choice to vaccinate is left to the parent. Ideally they’re guided by the counsel of their health care professionals. When viewed outside that insulated dynamic, however, the decision to skip vaccines comes with ramifications.
“There are two important reasons to get vaccinated,” said Josh Crabtree, M.D., senior vice president of clinic operations at Sanford Health. “One is for your own individual protection. The second reason is for the protection of those around us.”
In short, the internet is an unruly launch pad for medical theories. It is a place where you can find any research to support your beliefs, regardless of what they might be. In some cases, these beliefs can contradict what most would consider exhaustively researched, undisputed scientific facts. Increasingly, primary care doctors play an important role in separating truth from fiction for conscientious parents trying to sort through it all.
“The important thing to remember is that parents are trying to do the right thing for their children,” said Ann Safo, D.O., a family doctor in integrative medicine for Sanford Health. “They’re trying to make informed decisions. Somewhere along the line, they have stopped trusting our medical system and their doctors.”
Measles vaccine: a brief history
To summarize, before there was a vaccine for measles, nearly all children contracted the disease in childhood. Unfortunately, sometimes those cases came with dramatic consequences.
Before 1963, when a vaccine was officially licensed, there were an estimated 3 to 4 million cases of measles a year in the U.S. That number dropped to 1,497 reported cases in 1983. That was the lowest reported total in history at that time. Remarkably, in 2004, the total fell to 37 reported cases in the U.S.
“The two biggest impacts that we’ve had as a health industry are, No. 1, immunizations. No. 2 is antibiotics,” Dr. Crabtree said. “It’s really hard to argue the benefit that vaccinations have had to us as a society.”
Subsequently, a mumps vaccine (1967) and rubella vaccine (1969) were added to the measles vaccine in 1971. The combined vaccine is commonly referred to as MMR. It has been administered to children in the U.S. and around the world for decades.
In the meantime, it had a dramatic effect on public health. For example, an epidemic of rubella (German measles) in 1964-65 infected 12.5 million Americans, according to the CDC, killing 2,000 babies while causing 11,000 miscarriages. The CDC reports less than 10 cases a year now. Similarly, Minnesota has not had a single case of rubella since 2009.
“The concern is that we’ll see a resurgence of preventable diseases,” said Bruce Evink, M.D., a Sanford Health family medicine doctor. “We’re talking about diseases we’ve been extremely effective in reducing significantly, or almost eliminating entirely.”
Most importantly, with more than 90 percent of children in the United States receiving the MMR vaccine, public health is still posting a one-sided victory over those inclined to avoid immunization. While that fact dilutes the call for worst-case scenarios, increases in measles cases remain a genuine threat to public health.
“I try not to be too fear-based about anything,” Dr. Safo said. “These anti-vaccination supporters are not people to be feared, but rather, they fear that vaccines will hurt their child. I think the people I see should get vaccinated. My kids are fully vaccinated. I’m fully vaccinated. We need to educate, and that starts with transparency.”
Vaccine naysayers can be a persistent bunch. Those apprehensive about immunization are sometimes not easily convinced.
“I’m a family medicine doctor, and that starts with developing a trusting relationship,” Dr. Evink said. “I think most patients still desire and still have that with their physicians. But it is difficult to sway people who come from the premise that the CDC is evil and the government is just trying to push things through that may not be for the benefit of patients.”
Vaccination encouragement is best delivered via accurate information. However, there can be occasional road blocks.
For example, some parents flatly tell their primary care doctors they’re opposed to vaccinations of any kind. Others want to talk about extending the process over a longer time frame. Still others want to wait for children to get older so they can make their own choices.
And to the disbelief of many primary care providers, some will shy away based on the thoroughly scientifically discredited assertion that vaccines have a link to autism.
“When you’re an adult and you have a child that you’re now responsible for, it can be troublesome for some to make these kinds of decisions,” Dr. Crabtree said. “There can be that concern about making a decision for another individual, but I think those are our responsibilities as health care providers and as parents. Be informed about making those decisions for your kids and protect them to the best of your ability.”
Vaccines and the law
All 50 states have legislation requiring specified vaccines for students. All provide medical exemptions. Of those, 45 states and Washington, D.C., give exemptions for people based on religious beliefs. Fifteen states allow for exemptions based on personal beliefs.
As of Aug. 29, 31 states reported cases of measles in 2019, according to the CDC. The organization also reports that 125 of those afflicted required hospitalization.
In contrast, hospitalization numbers for 2019 exceed the total number of reported cases from just two years ago.
It is why providers greet increases like those reported in 2019 with concern both as a matter of public welfare and the personal well-being of patients.
“It’s easy to look at anti-vaccination trends cynically,” Dr. Crabtree said. “But those parents and individuals are trying to take a greater role in their own health. There is an opportunity here because they’re looking for answers. That’s why it’s important that we at Sanford take an active role in the education process.”
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