A measles outbreak in Ohio is raising concerns about the spread of the disease and how a drop in childhood vaccination rates could lead to new outbreaks.
Eighty-five cases were reported in Ohio on Friday, mostly in Columbus and other parts of Franklin County, according to Columbus Public Health. Most of these cases were in unvaccinated children. Hospitalization was required for 34 of those infected.
This is not the only recent measles outbreak in the country.
Minnesota had 22 cases last year in the Twin Cities area.
The outbreaks, which come amid a surge in anti-vaccine sentiment, are raising concerns among health experts about whether lower vaccination rates will lead to further spread of diseases that vaccines can protect against.
“With all vaccine-preventable diseases, we always worry about the lack of herd immunity,” says physician Susan Koletar, director of the division of infectious diseases at Ohio State Wexner Medical Center.
Herd immunity occurs when enough people are immunized through vaccination or natural infection to prevent the spread of a disease. Measles is so contagious that vaccination rates must be at least 95% to eliminate the disease.
The Ohio outbreak began in October 2022, with the bulk of cases occurring from mid-November to early December. These community cases are believed to be linked to one of four travel-related measles cases, says physician Mysheika W. Roberts, who serves as Columbus’ health commissioner.
Although most of the cases are in unvaccinated children, six of them had received their first of two doses of the combined measles, mumps and rubella (MMR) vaccine. Twenty-four other children were too young to receive doses, according to the agency’s website.
The United States was declared measles-free in 2000, but travelers periodically bring infections. People who visit countries where measles is endemic, meaning there is regular transmission in the population, may return to their home communities and trigger a local outbreak.
“The simple fact that people who weren’t vaccinated traveled to a measles-endemic country and then were allowed back into the United States, where they likely caused this outbreak, concerns me as a measles professional. public health,” Roberts says.
One of the potential reasons why these measles outbreaks may occur is that vaccination coverage rates have dropped during the pandemic.
The Centers for Disease Control and Prevention (CDC) reports that vaccination rates among kindergarteners are high, but coverage for the 2021-2022 school year has fallen to 93% from 95% for the 2019 school year. -2020.
The risk of contracting vaccine-preventable diseases has been particularly increased for children who live in low-income households or in rural areas, as vaccination coverage has declined for these groups by 4-5% during the pandemic, according to the CDC.
This drop in childhood vaccinations stems in part from disruptions during the pandemic, as well as financial and logistical obstacles, the CDC reported. But growing vaccine hesitancy and the anti-vaccine movement have also contributed and are a major factor behind recent measles outbreaks.
The United States experienced its highest annual number of measles cases in recent history in 2019 with 1,274, most of which occurred in eight underimmunized communities, according to the CDC.
“We live in a generation where most people who are hesitant about vaccines have never experienced any of these diseases,” Koletar says. “And they never experienced any of these diseases due to widespread vaccination practices.”
“I think a lot of parents feel like since they don’t see measles in our community, it’s safe for them not to have their child vaccinated,” Roberts says.
She attributes part of the reluctance to vaccination to the circulation of false information. A debunked theory linking the MMR vaccine to autism is one example. Unfounded concerns driven by this theory may cause some parents to delay MMR vaccination until just before their child starts school, which could mean the child gets their first dose when they are around 4 years old at the time. instead of 12 months.
The MMR vaccine has been around since the 1960s and is very, very effective, notes Roberts. “We failed to eliminate measles without the MMR vaccine.”
The politicization of vaccines during the COVID-19 pandemic has also fueled anti-vaccine attitudes, she says.
“The Anti Vaxx [and] the vaccine hesitant community likely grew as a result of this pandemic and spread from COVID-19 hesitant to all vaccine hesitant,” notes Roberts.
Each family can weigh their own personal risk and make decisions that way, says vaccine safety researcher Elyse Kharbanda. Willingness to get vaccinated may increase when transmission is high or there is recent memory of an outbreak, but once that subsides, vaccine acceptance may decline, she continues.
Amid declining vaccination rates, Koletar fears there may be an increase in other vaccine-preventable diseases, such as tetanus, rubella and chickenpox. Rubella can be harder to diagnose than measles and can sometimes go undetected, according to Koletar.
People in their late teens and adults who haven’t had chickenpox or been vaccinated against it can get really sick if they get chickenpox, she adds. “As a doctor, these are scary times, especially if you have a young pregnant woman who gets chickenpox.”
For now, the situation seems positive in Ohio. The most recent case of measles was detected on December 24, which means that if there are no new cases until February 4, the outbreak can be officially declared over.
Looking ahead, there is a need for further research into interventions that would help get more people in vaccine-resistant communities to accept vaccines, according to Kharbanda.
Interventions like alerts and letters are “effective in promoting vaccination to families who intend to have their children vaccinated and who have been busy and forgotten,” Kharbanda told The Hill.
But “those kinds of simple interventions really don’t work with families and communities who are fearful and resistant to vaccines,” she says. It takes time and good relationships with communities to understand what beliefs perpetuate vaccine hesitancy and gain trust, she adds.
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