2019 Pacific Northwest measles outbreak

Last updated
2019 Pacific Northwest measles outbreak
DateDecember 31, 2018 (2018-12-31)
Location Portland metropolitan area and Hawaii
Coordinates 45°38′N122°36′W / 45.633°N 122.600°W / 45.633; -122.600
Type Outbreak
Cause Measles morbillivirus and vaccine hesitancy
First reporterPublic Health Department of Clark County
OutcomeClark County public health emergency (January 18, 2019); Washington state of emergency (January 25, 2019)
Website www.clark.wa.gov/public-health/measles-investigation

In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; [1] outbreaks in 2019 in areas including Brooklyn [2] and Rockland County, New York [3] have since seen far greater numbers of cases.

Contents

Background

In late December 2018, the Public Health Department of Clark County, Washington identified a patient with a high fever and rash, which are symptoms characteristic of measles. This was Clark County's first confirmed case of measles. [4] The case sparked immediate concern, as measles is a highly contagious disease: the virus can spread through coughing or sneezing, and it is infectious enough that 90% of people in close proximity to the patient, if unvaccinated, will contract measles. [5] Measles is also highly contagious because, for up to two hours, it can live on both surfaces and in airspaces. [5] The area where the outbreak began and spread is considered an anti-vaccination hotspot. [6] [7] [8] In Clark County, the measles vaccination rate was 78% at the time of the outbreak, too low for effective herd immunity. [7] The outbreak, which has struck mostly voluntarily non-immunized children, may have started at a Vancouver, Washington church attended by largely immigrant parents "who don't trust government – or vaccination programs" after residing in the former Soviet Union. [9] The virus was reintroduced to the Pacific Northwest in December 2018 by an "international traveler" entering Clark County. [1]

History and progression of outbreak

Through the end of December 2018 and into January 2019, the number of measles cases in Clark County continued to increase, even after patients were placed in quarantine environments. [10] Clark County public health officials identified that one of the measles patients from Oregon had been previously traveling through the Portland International Airport on January 7, which may have been related to more recent measles cases identified in the following weeks located in the states of California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington that emerged throughout January 2019. [10] [11]

On January 4, 2019, the Clark County health department advised the public that one case had been detected, and on January 15, two more were confirmed. [12] On January 18, 2019, with 19 known cases of measles, Clark County officials declared a health emergency. [6] On January 25, with 30 cases reported, Washington governor Jay Inslee declared a statewide medical state of emergency in response to the "extreme public health risk" and called on the Washington Military Department to assist. [13] [14] [15] By January 28, 36 cases had been reported, one of which was in the Seattle area. [16] [17] [18] Two children visiting Hawaii from the outbreak area, who had not been vaccinated and developed the disease, were quarantined on the Big Island in late January. [19] By January 30, 40 cases had been confirmed. [20] By January 31, there were 43 confirmed cases and the state of North Dakota sent a medical response team to aid the Northwest. [21] By February 15, 53 cases had been identified, 47 in non-immunized individuals. [22] By February 24, 65 cases had been confirmed in Clark County. [23] By March 18, the number of confirmed cases reached 73. [24]

County public health emergency and statewide state of emergency

On January 18, once 19 measles cases had been identified, [6] a public health emergency was declared throughout Clark County, Washington by Eileen Quiring, the Clark County Council Chair. [25] This public health emergency was declared to allow the county to access public health resources outside of those available in Clark County, as well as to raise public awareness about the outbreak to encourage citizens to take necessary health precautions.[ citation needed ]

On January 25, a state of emergency was declared throughout the entire state of Washington by Governor Jay Inslee. [4] In the official proclamation, Governor Inslee stated that "the existence of 26 confirmed cases in the state of Washington creates an extreme public health risk that may quickly spread to other counties". [26] Inslee's concluding point discussed the implications of the outbreak for the well-being of the state itself: "The measles outbreak and its effects impact the life and health of our people, as well as the economy of Washington State, and is a public disaster that affects life, health, property or the public peace." [26]

Personal belief exemptions

Incidence of measles has decreased drastically since the introduction of the MMR vaccine. Measles US 1938-2019.png
Incidence of measles has decreased drastically since the introduction of the MMR vaccine.

None of the 59 patients identified as of February 16, 2019 had received their complete set of two MMR (measles, mumps, rubella) vaccinations. [4] Proper protection against measles, mumps, and rubella is best secured when children receive their first of two vaccine doses at 12 to 15 months of age, and their second dose between ages 4 to 6 years old. [27] According to the Center for Disease Control, 91.9% of children aged 19 to 35 months had received at least one dose of the MMR vaccine in the year 2017. [28] For the 2017–2018 academic year in Clark County, personal belief exemptions were filed on behalf of 7.9% children enrolled in school (kindergarten through grade 12). [29] Personal belief exemptions (PBE) are forms that can be filled out by parents that excuse children from school-wide immunization requirements on the premise of moral, philosophical, or religious opposition. [30] Only four of the 50 United States prohibit the utilization of PBEs entirely: Mississippi, West Virginia, California, and most recently in June 2019, New York. [29] 18 states, including Oregon and Washington, however, allow individuals to opt out of vaccinations for themselves and/or their children on the premise of conflicting religious, moral, or personal beliefs. [29] There is a direct positive correlation between strictness of state vaccination laws and rates of vaccination among states. [29]

Public response

CDC MMR Vaccine Information Statement. CDC Vaccine Information Statement for MMR Vaccine.pdf
CDC MMR Vaccine Information Statement.

As the measles outbreak grew, news coverage expanded across the country about not just the outbreak itself, but whether or not state or government mandated vaccination policies could have prevented its spread. According to Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, the Pacific Northwest is home to an outspoken population of anti-vaccination lobbyists that are likely in part responsible for the increased prevalence of personal belief exemptions throughout the region. [31] Despite the area's relatively low immunization rates, health officials have observed a recent spike in the number of people throughout Washington and Oregon interested in receiving a measles vaccine. [32] Public health administrator Shawn Brennan, an employee at Sea Mar Community Health Center in Vancouver, Washington explained that the increased public concern had pushed the clinic to order nearly 10 times as many vaccine doses than average. [32]

Press coverage regarding the Pacific Northwest measles outbreak fostered nationwide interest in the spread of the disease. The topic "measles" was the most searched it had ever been in the United States since the 2015 Disneyland outbreak, according to Google Trends. [33] With the identification of more cases, public outrage continued to grow as the Washington Department of Health disclosed that, as of February 21, 2019, over one million dollars had been spent on the outbreak, largely to cover the costs of medical supplies and staff. [34] “This is taxpayer money for something that could have been completely, utterly preventable in the first place,” explains Clark County public health director Alan Melnick, in reference to the MMR vaccine designed to prevent the spread of measles. [34]

In the past decade, epidemiologists have linked decreased immunization rates to the increasing prevalence of social media. [35] The Internet is the primary vessel in which misinformation about health consequences of vaccinations is spread, most of which is in relation to Andrew Wakefield’s study linking the MMR vaccine to the development of autism that has since been discredited by the CDC. [36]

Social media platforms have taken their own individual efforts to prevent the dissemination of false information. As of September 2018, Pinterest had banned users from searching for content about vaccines. [37] In January 2019, Facebook announced that it will be banning posts promoting anti-vaccination propaganda, and the website will no longer be suggesting anti-vaccination pages or groups for users to join. [38] In February 2019, YouTube stated that any user or channel endorsing anti-vaccination content will be demonetized entirely, and not receive any funding for advertisements played before videos. [39]

See also

Related Research Articles

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">MMR vaccine</span> Any of several combined vaccines against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. The scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

Vaccination and religion have interrelations of varying kinds. No major religion prohibits vaccinations, and some consider it an obligation because of the potential to save lives. However, some people cite religious adherence as a basis for opting to forego vaccinating themselves or their children. Many such objections are pretextual: in Australia, anti-vaccinationists founded the Church of Conscious Living, a "fake church", leading to religious exemptions being removed in that country, and one US pastor was reported to offer vaccine exemptions in exchange for online membership of his church.

The MMRV vaccine combines the attenuated virus MMR vaccine with the addition of the chickenpox vaccine or varicella vaccine. The MMRV vaccine is typically given to children between one and two years of age.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper authored by Andrew Wakefield and published in The Lancet falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaxxers.

A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by State or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.

<span class="mw-page-title-main">Health in the United States</span> Overall health of the population of the United States

Health may refer to "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.", according to the World Health Organization (WHO). 78.7 was the average life expectancy for individuals at birth in 2017. The highest cause of death for United States citizens is heart disease. Infectious diseases such as sexually transmitted diseases impact the health of approximately 19 million yearly. The two most commonly reported infectious diseases include chlamydia and gonorrhea. The United States is currently challenged by the COVID-19 pandemic, and is 19th in the world in COVID-19 vaccination rates. All 50 states in the U.S. require immunizations for children in order to enroll in public school, but various exemptions are available by state. Immunizations are often compulsory for military enlistment in the United States.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decrease. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

Warnings About Vaccination Expectations NZ (WAVESnz), formerly the Immunisation Awareness Society (IAS), is a New Zealand anti-vaccination lobby group.

Robert William Sears, known as Dr. Bob, is an American pediatrician from Capistrano Beach, California, noted for his unorthodox and dangerous views on childhood vaccination. While Sears acknowledges the efficacy of vaccines—for instance, he supports the claim that Chicken pox, measles, whooping cough, polio, diphtheria have all disappeared because of vaccines—he has proposed alternative vaccination schedules that depart from accepted medical recommendations. His proposals have enjoyed celebrity endorsement but are not supported by medical evidence and have contributed to dangerous under-vaccination in the national child population. While he denies being anti-vaccine, Sears has been described by many as anti-vaccine and as a vaccine delayer.

<span class="mw-page-title-main">Epidemiology of measles</span>

Measles is extremely contagious, but surviving the infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000. Due to the development of vaccination against measles, the world has seen a 99% decrease in measles related cases compared cases before the vaccine was developed.

The 2019 measles outbreaks refer to a substantial global increase in the number of measles cases reported, relative to 2018. As of April 2019, the number of measles cases reported worldwide represented a 300% increase from the number of cases seen in the previous year, constituting over 110,000 measles cases reported in the first three months of 2019. In the first half of 2019, the World Health Organization received reports of 364,808 measles cases from 182 countries, up 182% from the same time period of 2018 when 129,239 confirmed cases were reported by 181 countries.

<span class="mw-page-title-main">Measles resurgence in the United States</span> Sharp increase in measles cases between 2010 and 2019

Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. However, it continues to be reintroduced by international travelers, and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks.

The 2019 New York City measles outbreak was a substantial increase in the number of measles cases reported in the state of New York, primarily in New York City and neighboring Rockland County, New York in 2019, relative to the previous year.

<span class="mw-page-title-main">Vaccination policy of the United States</span> Overview of the vaccination policy in the United States of America

Vaccination policy of the United States is the subset of U.S. federal health policy that deals with immunization against infectious disease. It is decided at various levels of the government, including the individual states. This policy has been developed over the approximately two centuries since the invention of vaccination with the purpose of eradicating disease from the U.S. population, or creating a herd immunity. Policies intended to encourage vaccination impact numerous areas of law, including regulation of vaccine safety, funding of vaccination programs, vaccine mandates, adverse event reporting requirements, and compensation for injuries asserted to be associated with vaccination.

<span class="mw-page-title-main">2019 Samoa measles outbreak</span> Measles epidemic in Samoa in late 2019

The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three percent of the population were infected. The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.

Misinformation related to immunization and the use of vaccines circulates in mass media and social media in spite of the fact that there is no serious hesitancy or debate within mainstream medical and scientific circles about the benefits of vaccination. Unsubstantiated safety concerns related to vaccines are often presented on the internet as being scientific information. A high proportion of internet sources on the topic are "inaccurate on the whole" which can lead people searching for information to form "significant misconceptions about vaccines".

The Immunisation Advisory Centre (IMAC) is a New Zealand-wide organisation which provides information and training about immunization and vaccine-preventable diseases to health care professionals, government bodies, and individuals. It co-ordinates the nation's immunisation programmes, policy advice and research. It was launched in 1997, and is based at The University of Auckland.

References

  1. 1 2 Susan Scutti (January 30, 2019), Measles outbreaks in Washington and New York challenge public health systems, CNN
  2. ↑ New York City measles page
  3. ↑ Measles information, Rockland County
  4. 1 2 3 "Measles investigation". Clark County Washington. 2019-01-14. Retrieved 2019-03-20.
  5. 1 2 "Measles | Transmission | CDC". www.cdc.gov. 2019-03-12. Retrieved 2019-03-20.
  6. 1 2 3 Isaac Stanley-Becker (January 23, 2019), "Officials in anti-vaccination 'hotspot' near Portland declare an emergency over measles outbreak", The Washington Post
  7. 1 2 Measles outbreak spreads in anti-vaccination Northwest 'hot spot', Associated Press, January 26, 2019 – via Los Angeles Times
  8. ↑ Molly Solomon (January 29, 2019), "Measles Outbreak Begins In Washington State And Spreads To Oregon", Morning Edition , NPR
  9. ↑ Church possible first measles exposure site for Washington state outbreak, KATU/CNN, January 29, 2019, archived from the original on January 30, 2019, retrieved January 30, 2019– via KSLA
  10. 1 2 "Measles | Cases and Outbreaks | CDC". www.cdc.gov. 2019-03-18. Retrieved 2019-03-21.
  11. ↑ "Officials in anti-vaccination 'hotspot' near Portland declare an emergency over measles outbreak". Washington Post. Retrieved 2019-03-21.
  12. ↑ PUBLIC HEALTH INVESTIGATING TWO ADDITIONAL CONFIRMED, 11 SUSPECTED MEASLES CASES, Clark County, Washington Public Health, January 15, 2019
  13. ↑ "Inslee declares state of emergency over Washington measles outbreak", The Seattle Times, January 25, 2019
  14. ↑ "Measles Outbreak Grows in Northwest US, 30 Cases Reported", The New York Times, January 25, 2019
  15. ↑ Inslee declares local public health emergency after identifying outbreak of measles (press release), Communications Office of the Governor of Washington State, January 25, 2019, the Washington Military Department is coordinating resources to support DOH and local officials
  16. ↑ "Measles Outbreak Near Portland, Oregon, Sickens 35", The New York Times, January 28, 2019
  17. ↑ "Washington State declares state of emergency following measles outbreak", The Jerusalem Post , January 29, 2019
  18. ↑ Amir Vera (January 29, 2019), Washington is under a state of emergency as measles cases rise, CNN
  19. ↑ Jared Gilmour (January 29, 2019), "Hawaii quarantines Washington kids till they beat measles: 'They are gone, thankfully'", Tri-City Herald , Kennewick, Washington
  20. ↑ Gillian Flaccus (January 30, 2019), Patients in Northwest measles outbreak traveled to Hawaii, Associated Press – via Yahoo News
  21. ↑ North Dakota Sends Team to Help With Measles Breakout, Associated Press, January 31, 2019 – via U.S. News & World Report
  22. ↑ Current investigation, Clark County Public Health, February 15, 2019
  23. ↑ Jack Heffernan (February 24, 2019), "Clark County confirms no new measles cases", The Columbian, Vancouver, Washington
  24. ↑ Stayner, Wyatt (March 18, 2019). "Clark County measles cases rise to 73 confirmed; two more suspected". The Columbian. Vancouver, Washington – via The Spokesman-Review (Spokane).
  25. ↑ "County declares public health emergency due to measles outbreak". Clark County Public Healthy. 18 Jan 2019.
  26. 1 2 Inslee, Jay (25 Jan 2019). "19-01 State of Emergency" (PDF). Washington Governor.
  27. ↑ "MMR Vaccination | What You Should Know | Measles, Mumps, Rubella | CDC". www.cdc.gov. 2018-02-02. Retrieved 2019-03-21.
  28. ↑ "FastStats". www.cdc.gov. 2018-09-11. Retrieved 2019-03-21.
  29. 1 2 3 4 Belluz, Julia (2019-01-27). "Washington declared a public health emergency over measles. Thank vaccine-refusing parents". Vox. Retrieved 2019-03-21.
  30. ↑ Diekema, Douglas S. (2014-03-18). "Personal Belief Exemptions From School Vaccination Requirements". Annual Review of Public Health. 35 (1): 275–292. doi: 10.1146/annurev-publhealth-032013-182452 . ISSN   0163-7525. PMID   24328988.
  31. ↑ Romo, Vanessa; Neighmond, Patti (28 January 2019). "Washington State Officials Declare State Of Emergency As Measles Outbreak Continues". NPR.org. Retrieved 2019-03-21.
  32. 1 2 "In A Measles Outbreak, Demand For Vaccine Spikes". NPR.org. Retrieved 2019-03-21.
  33. ↑ "Google Trends". Google Trends. Retrieved 2019-03-21.[ permanent dead link ]
  34. 1 2 "Cost of Washington's measles outbreak tops $1 million; expected to climb higher". The Seattle Times. 2019-02-21. Retrieved 2019-03-21.
  35. ↑ Brunson, E. K. (2013-05-01). "The Impact of Social Networks on Parents' Vaccination Decisions". Pediatrics. 131 (5): e1397–e1404. doi:10.1542/peds.2012-2452. ISSN   0031-4005. PMID   23589813. S2CID   26115464.
  36. ↑ "Vaccines Do Not Cause Autism Concerns | Vaccine Safety | CDC". www.cdc.gov. 2019-02-06. Retrieved 2019-03-21.
  37. ↑ McMillan, Robert; Hernandez, Daniela (2019-02-20). "Pinterest Blocks Vaccination Searches in Move to Control the Conversation". Wall Street Journal. ISSN   0099-9660 . Retrieved 2019-03-21.
  38. ↑ Wagner, Kurt (2019-03-07). "Facebook is finally cracking down on anti-vaccination hoaxes". Recode. Retrieved 2019-03-21.
  39. ↑ Shu, Catherine (February 2019). "YouTube demonetizes anti-vaccination videos". Tech Crunch.

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