Anti-vaxxers represent only about 2 percent of American families, although you’d be forgiven for thinking they’re more numerous. They certainly make a lot of noise and have some world-famous adherents. However, like malaria-carrying mosquitoes, this tiny group that punches above its weight may be on the verge of creating a public health problem for us all.
Peter J. Hotez, a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, recently took to The New York Times to warn that we could see an outbreak of measles, “one of the most contagious and most lethal of all human diseases,” this year. In fact, based on this January article in the Los Angeles Times, it looks like Hotez’s prediction has already begun materializing in California.
Measles, which was considered eradicated in the United States as recently as 2000, isn’t a retro-chic trend worth reviving. “15 people die every hour worldwide from measles, according to the World Health Organization,” notes the Los Angeles Times. Yet, like some deadly cat with nine lives, measles is making its American come-back.
Herd Immunity Is Serious
Recall the 2014 measles outbreak at Disneyland. In spite of knowing that “145 people in the U.S. and about a dozen others in Canada and Mexico” became infected, some parents remain firm vaccine opponents. According to Dr. Dean Blumberg, chief of pediatric infectious diseases at the University of California at Davis, the vaccination exemption rate increased from 1.7 percent in 2014-5 to 1.9 percent in 2015-6 nationally among kindergarteners, although he adds that “states are inconsistent in how they measure this, and state laws and regulations have been changing” — as they should.
If you’re the parent of an immuno-compromised child, or perhaps of an infant — as I am — Hotez’s warning is chilling. With the benefits of modern aviation, no community and its diseases are ever completely isolated, unless there’s a formal quarantine.
I intend to vaccinate my daughter, but she’s still too young for most of the American Academy of Pediatrics’ immunization schedule. That means we’re relying on herd immunity for her safety.
The national vaccination rate currently hovers around 95 percent, but Blumberg explains it must be more like 96 percent going forward for herd immunity to fully operate. As more families with healthy, older children opt out of immunizations, how can you protect a child who can’t (yet) be vaccinated? For those who may also be in my boat, I posed that question to some medical experts.
How to Recognize Measles
The first tip? Arm yourself with information. Most American parents with young children have never personally encountered measles, so they wouldn’t recognize it. Dr. Grant Christman, an assistant professor of clinical pediatrics at the University of Southern California’s Keck School of Medicine (and my college friend), recommends starting with the Centers for Disease Control and WHO websites.
It’s important to know “that the rash isn’t the first thing you see. Kids start off with fever, cough, runny nose, and conjunctivitis (pink/red eyes), so early on, measles can look like a lot of other common viruses.”
Next, there is some good news. Infants with vaccinated mothers are born with preliminary protection. Blumberg explains that a mother passes along her immunity “primarily during the third trimester. So the children are born with some protection against these diseases. The maternal antibodies decay over time, but they serve as a critical bridge of protection while the child[’s] . . . immune system matures.”
Talk to Your Child’s Doctor
As a parent, you also have some leverage, assuming you live near more than one pediatrician. Christman notes that while some pediatricians accept vaccine-refusing patients and others do not, your family can always vote with your feet: “If your pediatrician keeps vaccine refusing patients, there is a greater chance your baby will be exposed to measles and other preventable diseases during well child visits. I would guess that most pediatricians up until now have felt more pressure from vaccine refusing parents than from the rest of us. This won’t change until parents who vaccinate start asking their pediatricians about this prior to being seen at their practice.” So if this matters to you, say something.
Stay Away from Contagious People
Dr. Avigayil Elkin, a pediatrician in New Jersey, further advised: “MMR can’t be given before age one for it to ‘count’ for school purposes, but we do give MMR as early as six months in special circumstances- overseas travel would be one of them. . . . just get the baby immunized on time according to the recommended schedule and limit time spent in crowded or close public environments whenever possible when the baby is very young.”
The crowds and public places are, of course, a real challenge, if you’re accustomed to using public transportation or have older kids too, like my family. So, what should parents do there?
Blumberg suggested several things. First, “95% of kindergarteners in the U.S. have received the MMR vaccine (per the CDC, 2015-6 school year). But the immunization rate varies from 87 percent to 99 percent by state” and by individual community. So Blumberg advises parents to think about this issue on a local basis.
For starters, ask about vaccination rates before choosing your child’s day care facility or school district. Ensure that those frequently interacting with your child, including family members and regular caregivers, are vaccinated.
Second, avoid being around people who are ill, by choosing caregiving settings with rules about keeping sick children home and declining play dates with anyone who is ill. Blumberg acknowledges this is easier said than done. He suggests letting friends and family know this is a priority for your family.
Third, pick a pediatrician who segregates healthy and ill children in the waiting room, so your healthy child doesn’t leave a well visit feeling sick.
Fourth, there’s the matter of diet. Breastfeeding protects infants and toddlers. While “for older children, a diet high in fruits, vegetables, and whole grains will assure adequate vitamins and micronutrients (such as selenium and zinc) that are important for immune function.”
Talk to Your Elected Officials
Finally, if you’re in an activist mood, contact the new secretary of Health and Human Services and the new secretary of Education and ask them to speak out on this. Also, investigate whether you live in a state where personal belief exemptions are freely granted. If so, consider calling your state legislators and urging them to introduce legislation requiring vaccinations for kindergarteners who don’t qualify for medical exemptions.
California previously had lax vaccination legislation, but it “is now one of three states that forbid children from opting out of vaccines because of religious or personal beliefs.” That’s certainly a start. Now, we just need to encourage reluctant parents everywhere: If you have children healthy enough to vaccinate, do it. You’ll be protecting your own kids, along with everybody else’s.