2019 Measles outbreak reaches the Bay Area

To recap what’s been going on nationally with the measles outbreak of 2019, as of February 23, there have been 66 confirmed cases of the disease in Washington state. Clark County is said to be the epicenter of the outbreak and Washington state officials have declared a state of emergency. Since the first case was reported on Dec. 31, 2018, the disease has shown up in Oregon, where, as of February 25, there were six confirmed cases. As of March 6, the disease has reached the Bay Area.

Measles tends to spread only to those people who have not been properly vaccinated against the disease. The vaccination that’s used is referred to in medical jargon as MMR, which stands for measles, mumps and rubella. And vaccination is currently the only way to prevent measles. On a positive note, the news reporting around this latest outbreak appears to have started to get many in the anti-vaccination camp motivated get their children immunized. According to the Centers for Disease Control and Prevention, 7.5 percent of kindergarten age children in Washington were unvaccinated for non-medical reasons.

In California, most communities are doing an effective job and ensuring public-school educated children are vaccinated, but there’s still work to be done. Evidence of California state and county vaccination rates can be found in the 2017-2018 Kindergarten Immunization Assessment.

Based on the assessment, the overall all required vaccine (ARV) rate in CA was 95.1 percent in 2018. This has climbed from around 90 percent in 2014. Marin and San Francisco counties remain in the yellow range, however, with MMR vaccination rates that are below 95%. Marin and San Francisco ARV is 94 percent. For context, Alameda is at 97.1 percent, and San Mateo is at 96.9 percent.

I believe the lower vaccination we’re seeing in San Francisco and Marin has to do with pockets of certain "private" schools. Public schools generally have very high rates. Exceptional schools tend to coalesce parents with history of vaccine refusal. In my observation, parents scoot around the system by finding a physician to sign off for their child's medical exemption and therefore filling criteria for Senate Bill 277. What more, Alternative medicine physicians are becoming more prevalent in many communities. These types of medical exemptions have climbed since 2014 (from < 0.5% to ~ 2% of private school students). These schools have children where diseases like measles could spread quickly. It should also be noted that while Marin and SF vaccination rates may be lower than the California average, the lowest ARV rates are in rural CA counties, with Mendocino 86.8 percent, Humboldt 88.4 percent, Calaveras 88.1 percent, Nevada 81.7 percent, Sutter 78.2 percent, and Trinity 84.5 percent.

In its “Ten threats to global health in 2019,” the World Health Organization (WHO) cites vaccine hesitancy as a threat to the progress made in tackling vaccine-preventable diseases. WHO says, “Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.”

It’s sad to see elected officials, such as Texas state representative Bill Zedler, suggest that measles can be treated with antibiotics, or Arizona's State Rep. Kelly Townsend suggest that mandatory vaccination is communist. I’m further dismayed that people believe non-rigorous explanations or hearsay for vaccine refusal. It should be noted that on March 5, The Annals of Internal Medicine published a comprehensive report that found no correlation between vaccination and autism. For those who still need further evidence of the power of vaccines, look at the statistics of deaths in the US in the early 1900's; most if not all of them were related to vaccine preventable conditions. If you haven’t done it yet, get your children vaccinated ASAP.

-Dr. Alexander Evens

Sidebar: Measles Facts and Figures

• Measles is a ubiquitous viral infection that only occurs in humans. Prior to vaccine available in the 1960's, this infection occurred in nearly every human being on the planet
• Measles viral infection was considered eradicated in the US in 2000. Since then, foreign travel and foreign travelers have contributed to the spread of this infection in U.S. citizens and predominately in scenarios where the patients are unvaccinated
• Disbelief in effective medical interventions (e.g. MMR vaccination) is the primary reason why measles is still a problem in this country
• At this time, we do not know the exact number of measles cases in Marin County for this year or prior years. We do know that Marin County has small but considerable areas of risk for transmission. There are communities of children that tend to coalesce together where their parents refuse many or all childhood vaccines
• There currently is no proven treatment to measles once contracted. WHO reports using high-doses in Vitamin A in hospitalized patients but this intervention is not proven in large clinical trials
• Measles is a potentially devastating illness. About 25 to 50 percent of those infected are sick enough to be hospitalized. About 1 in 500 die from complications. About 1 in 1000 develop encephalitis. Recent epidemiological review estimated about 1 in 600 children less than 5 years old may develop subacute sclerosing pan-encephalitis, which is a neurologic condition that occurs years after recovering from the initial illness

Bio: Dr. Alexander Evens, DO is the Medical Director of the Antimicrobial Stewardship Program at Marin General Hospital and director of Infection Control at Novato Community Hospital.