Yet measles, which had been eliminated in this country as of a decade ago, has emerged again – this time thanks to an infected foreign tourist visiting California’s Disneyland last December. At presstime, 141 people in 17 states and Washington, D.C., have been officially diagnosed with measles since Jan. 1.
So far no cases have been recorded in Missouri, although the illness has encroached as near as suburban Chicago, where 13 children and adults connected with a Kinder Care Learning Center have contracted it to date.
The outbreak has touched off a new firestorm of debate nationwide about the safety of childhood vaccinations, since unimmunized children are largely responsible for the measles’ recent spread; and babies, who are not vaccinated against measles until 1 year of age, are left unprotected. Precisely because it involves the health and safety of children, that debate can be an emotional one.
“I think it’s irresponsible to not vaccinate. I respect people’s right to choose but when it affects the population and could have been avoided, I take issue,” said Michelle, an area parent of a 6-month-old, “especially since I have to take my child to daycare, where she comes in contact indirectly with dozens of kids and can’t be vaccinated for another six months.”
One reason parents say they choose not to vaccinate is the perception that the vaccinations themselves are unsafe, a notion that most physicians dispute.
“Vaccines are safe,” said Dr. Rachel Orscheln, an infectious disease specialist at St. Louis Children’s Hospital. “They’re effective at preventing diseases that cause suffering, disability and even death.”
Orscheln also emphasized the need for parents to stick to the federally mandated vaccine schedule.
Much of the controversy over vaccine safety originally stemmed from a 1998 article in The Lancet, a British medical journal, citing research that reportedly showed a link between the incidence of autism and the MMR (measles, mumps and rubella) vaccine. That research has since been discredited by more than a dozen reputable studies. The article was retracted by the journal in 2010, and its primary author, who was found to have knowingly falsified the data, has had his medical license revoked.
“Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated,” reads a statement from Rob Ring, chief science officer of the nonprofit autism advocacy organization Autism Speaks.
The decision to opt out
To a number of local parents, however, the safety of vaccines is anything but settled science.
Lori, who asked that her last name not be used, said her son’s problems date back specifically to receiving immunizations at 18 months.
“Within a couple of days of this particular round of vaccines, it was as if a switch had been flipped,” she said. “There were constant over-the-top tantrums for seemingly no reason. He would stiffen his body, his eyes would become glazed over, and there was no getting through to him. He began having sensory issues … he would cry inconsolably for over an hour at bedtime. He would scream and kick the covers off of himself … he couldn’t fall asleep or stay asleep.”
Lori described a subsequent three-year period when, “more often than not, I had to hold him down as he hit, kicked and thrashed around, until he finally fell asleep. It was heartbreaking, stressful and exhausting for the whole family. We suspected an autism spectrum disorder, which was confirmed with his diagnosis just after his fourth birthday.”
Like Lori, Lisa also has concerns about vaccines. But her concerns are not about a link between the shots and autism, but rather her child’s ability to properly metabolize vaccine ingredients, some of which she believes may be toxic.
Lisa said she undertook extensive research after her then 10-year-old daughter had a “serious neurological” reaction to an over-the-counter pain medication, that included temporary severe depression along with a “zombie-like” demeanor in school. However, after painstakingly gathering “a 3-inch binder” full of information from experts and taking it to her pediatrician to discuss possibly forgoing required vaccine boosters, the doctor would not consider signing a medical vaccine exemption or even return Lisa’s calls.
“My kids are mostly vaccinated, but I have a lot of questions and I’ve definitely done my homework,” she said. “I think there’s a lot of fear-mongering in the media, and it’s hard to separate yourself from that.”
These parents are not alone. According to a report from the Washington, D.C., health policy organization Trust for America’s Health , Missouri’s “Immunization Gap,” meaning the number of children aged 19 to 35 months without all recommended immunizations, stood at 36.1percent in 2012.
Along with every other U.S. state, Missouri allows medical exemptions to vaccinations when obtained from a physician. It joins 47 other states in permitting vaccine exemptions for religious reasons. Seventeen states currently also allow a “philosophical, conscientious or personal belief” exemption, although Missouri does not.
In the event of a measles outbreak, area schools would follow the guidelines provided by the St. Louis County Department of Health. Those include immediate notification of all district parents about exposure to measles, and keeping students with suspected measles out of school until four days have passed since rash onset. Unvaccinated students would be kept out of school for 21 days, which is the total measles incubation period.
A public health threat
The last significant measles outbreaks in the St. Louis area occurred between 1985 and 1994 at The Principia in Town & Country and Principia College in Elsah, Illinois, whose Christian Scientist student populations are largely unvaccinated for religious reasons. The 1985 outbreak included 128 confirmed or probable cases of measles. Three of those young people died due to measles complications.
In 1989, there were 88 measles cases at The Principia K-12 school and 12 cases at Principia College. In 1994 a 14-year-old Principia student was the source of an outbreak that spread to 247 children, including many in public schools.
“Unvaccinated children can become a public health threat during outbreaks of diseases such as measles, since they can catch and propagate the infectious disease … patients are contagious four days before the onset of the (measles) rash,” said Dr. Glenn Cheng of Mercy Clinic Pediatrics in Chesterfield. “During outbreaks, pediatricians mainly worry about infants, as the MMR vaccine is not routinely given until 1 year of age … (but) if an outbreak occurs locally, MMR can be given as young as 6 months.”
Common complications of measles include ear infections; bronchitis, laryngitis or croup; and pneumonia. Cheng added that a fairly rare, though potentially fatal, complication is called non-sclerosing panencephalitis, in which the measles virus infects the brain and can eventually lead to coma and death.
Protected from liability
Vaccines have, without a doubt, been an enormous boon to world health. The United Nations International Children’s Emergency Fund (UNICEF) estimates that vaccines save approximately 9 million lives worldwide each year.
Large-scale administration of vaccines has brought seven major human diseases – smallpox, diphtheria, tetanus, yellow fever, whooping cough, polio, and measles ‒ under some control. The smallpox vaccine is no longer even required because the “herd immunity” effect created by widespread vaccination programs has succeeded in wiping out the disease.
Some argue that vaccines may have done their job almost too well over the past several decades, as many people have forgotten how serious these diseases once were.
In 1960, for example, the Centers for Disease Control and Prevention (CDC) reported 648 deaths in the U.S. from diphtheria, tetanus, pertussis and polio. By 1985, that number had fallen to 27.
By the mid-1980s, a greater focus on health and wellness along with greatly reduced exposure to diseases caused many to question vaccine safety. An increasing number of lawsuits alleging injuries were filed against vaccine manufacturers, resulting in skyrocketing liability and prices. Several manufacturers halted production, causing a vaccine shortage along with public health concerns about the return of epidemic disease. So in 1986, Congress passed the National Childhood Vaccine Injury Act (NCVIA). This act created a no-fault compensation program for victims of vaccine injuries, even as it shielded manufacturers from liability for a vaccine’s “unavoidable, adverse side effects.”
The act created the federally administered National Vaccine Injury Compensation Program (VICP) funded by an excise tax on each vaccine dose, which remains in effect today. Through the VICP, people who have proven vaccine injuries have been paid a total of more than $2.8 billion since 1989. The act also created the Vaccine Adverse Event Reporting System (VAERS), a nationwide database both healthcare professionals and parents can use to report adverse reactions of any kind to a vaccine.
A continued debate
Due to public health risks along with liability concerns, the mainstream medical community remains adamantly opposed to any decision not to vaccinate. Cheng estimated that well over half of area pediatricians will currently ask patients who decide not to vaccinate their children to seek treatment elsewhere.
“I strongly believe in vaccines,” he said. “At the same time, I have a number of patients who’ve chosen not to vaccinate. I think the primary reason for that is fear based on misinformation. I don’t think any physician can tell you that vaccines are 100 percent safe, but the benefits far outweigh the risks.”
He added that vaccines are continuously being made safer with time and testing, and that once-controversial ingredients like mercury have been eliminated. Where possible, he said he uses preservative-free vaccines in his practice.
But Lori is proof that there are two sides to every issue. She said in her son’s case, the comprehensive steps her family has taken since his autism diagnosis have made a world of difference.
“We’ve stopped vaccinating,” she said, “cleaned up his diet and reduced our exposure to toxins in many ways … Along with that, he’s worked with an occupational therapist, a board-certified behavior analyst and a speech therapist. My son has almost fully recovered and is currently in a third-grade classroom with no additional support.
“Regarding this whole vaccination debate, I just want people on the other side to understand that there are real people with real experiences and reasons for making this choice,” she added. “My son has come so far … too far to be set back again with another round of vaccines. I will not willingly give him something I know to be a poison to him in order to protect someone else from a ‘potential’ threat.”
Lisa has a similar view.
“I worry that as more and more vaccines come down the pipeline, and they’re added to the vaccine schedule, we’ll no longer be in charge of what’s injected into our bodies,” Lisa said. “The states are quietly removing exemptions (to vaccination). There’s a big gray area here, and I just wish everybody could come together to reasonably discuss it.”