- The Washington Times - Thursday, January 24, 2019

Health researchers are sounding the alarm about measles hot spots around the country where viral outbreaks are most likely because large percentages of residents have refused vaccinations based on religious or philosophical beliefs.

Medical professionals point out that current measles outbreaks in Washington state and New York have occurred among mostly unvaccinated communities and can threaten public health beyond those geographic areas.

Researchers last year warned of a dozen states and cities where significant numbers of healthy kindergartners were not being vaccinated, especially for measles. One of those cities — Portland, Oregon — is dangerously close to a measles outbreak in Clark County, Washington, which declared a public health emergency last week.

“We have to stop the non-medical exemptions,” said Dr. Peter Hotez, who led the research on anti-vaccine hot spots. “It’s really come down to an interesting battle where you have parents rights versus children’s rights, in some ways.”

Dr. Hotez and his colleagues found an increase of non-medical vaccine exemptions since 2009 in 12 of the 18 states that allow them — and at least 15 metropolitan areas with low rates of vaccination among school-age children. Their findings were reported in the scientific publication PLOS Journal in June.

Dr. Hotez is also the author of “Vaccines Did Not Cause Rachel’s Autism: My Journey As a Vaccine Scientist, Pediatrician, and Autism Dad,” which was published in October.

Measles was eliminated in the U.S. in 2000. But it is reintroduced by people returning from places where it is rampant, such as Europe, which had about 60,000 cases last year, and Israel, where an outbreak is ongoing.

“So you’ve got a situation then, where in these hot spots areas, like in Portland, like in Seattle, like in the North Texas area … where you have large numbers of unvaccinated kids, that’s the gasoline,” Dr. Hotez said. “Then, lighting the match is anybody coming in from Europe with a case of measles. It just spreads throughout the unvaccinated population.”

An infected person can unwittingly spread the highly contagious measles virus to 12-18 people because symptoms don’t appear until one or two weeks after infection. Symptoms include rash, red bumps, fever, cough, sore throat and inflamed eyes.

About 1 in 20 of those infected will develop pneumonia, and about 1 in 1,000 will die.

The goal in vaccination efforts is to cover at 95 percent of a population so that the contagion has fewer people to infect.

The antivaccination movement is based largely on a debunked study that connected the measles, mumps and rubella vaccine (MMR) to autism. But arguments from the far left and far right have called for freedom of choice in vaccinations, despite pleas from health officials.

There are 47 states that allow religious exemption from vaccinations; of those, 18 states also allow exemptions based on philosophical ideas or personal beliefs. In 2015, Vermont did away with the philosophical exemption but kept the religious exemption.

Mississippi, West Virginia and California are the only states where only a medical exemption is allowed.

Since 2009, the number of non-medical exemption requests have increased in Arkansas, Arizona, Idaho, Maine, Minnesota, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Texas and Utah.

Dr. Hotez and colleagues noted several metropolitan areas with pockets of high exemption rates, pointing out their proximity to larger population centers pose a more significant threat. This includes Seattle and Spokane in Washington and Portland in the Northwest.

Major cities in the Midwest that have high rates of non-medical exemptions include Troy, Warren and Detroit in Michigan; and Kansas City, Missouri. In the Southwest, Texas cities like Houston, Fort Worth, Plano and Austin have seen ongoing increases in non-medical exemptions.

New York is experiencing the worst measles outbreak — with about 118 cases in the New York City suburb of Rockland County and 58 cases in Brooklyn — wasn’t included in the analysis because it doesn’t have “personal belief” or “philosophical” exemptions.

The epicenter of the outbreaks, however, is in mostly unvaccinated children from Orthodox Jewish communities.Dr. Patricia Schnabel Ruppert, Rockland County’s health commissioner, said about 14,000 vaccines have been distributed since October and attitudes in the communities range from open acceptance to hostile refusals.

“We’ve had excellent cooperation and receipt of the vaccine by many people in the population, in that community,” she said, adding that vaccine skeptics became more amenable with more information.

“Then we have totally the anti-vaxxers and I think they’re a small but vocal group,” Dr. Schnabel Ruppert said. “We try to educate, to have them understand the scientific reasons to receive a vaccine and tell them about the myths that are debunked now scientifically, there’s no autism or developmental issues related to getting the MMR.

“But some are just so set in their ways no matter what you say. You could sit on your head and they’re not going to get the vaccine.”

Correction: An earlier version of this article incorrectly identified Pittsburgh as a hot spot for non-medical vaccine exemptions. The city was earlier identified in the Plos Journal study by Dr. Hotez and colleagues as a hotspot but was later corrected after researchers found they had incorrect information.

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