Measles: Is it really scary? What’s the big deal?

By Jackie Valley

Monday, Feb. 23, 2015 | 2:03 a.m.

Signs in hospital emergency rooms order people with fevers and coughs to cover up with face masks. Day care centers have limited outsiders’ contact with infants and sent home information packets about vaccinations, symptoms and precautions. Doctors have plastered waiting rooms with notices warning they won’t treat patients who aren’t immunized.

Measles is back in Nevada, and people are scared.

Six Clark County residents ­— three adults and three children — have been diagnosed with the virus, which spreads with coughs and sneezes and can linger in the air for two hours. Before January, Clark County had been free of measles since 2011.

Across the country, 141 people in 17 states have been infected, as of Feb. 13. Most are linked to an outbreak that began at Disneyland.

The Nevada cases show no direct tie to the California cluster. Epidemiologists don’t know how the virus got here.

But scientists do know whom to blame for its spread: the anti-vaxxers, a vocal community of people who choose not to immunize their children.

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When parents challenge Dr. Blair Duddy about the benefits of vaccines, the pediatrician delivers a well-honed speech outlining how immunizations protect children from diseases that could kill them. He shares statistics and cites studies. He hands out informational pamphlets.

Then he switches to dad mode. He points to a mouse pad stamped with a photo of his children.

“These are my kids,” Duddy says. “I vaccinate. I love my kids as much as you love yours. Please vaccinate your kids.”

If a parent still balks, Duddy, a pediatrician with HealthCare Partners Nevada, delivers the hammer: He recites his office’s 2-year-old policy to not accept unvaccinated children as patients.

Doctors like Duddy know what stops measles and other preventable diseases: vaccines. Once a common childhood infliction, measles was declared eliminated from the United States in 2000 because of a highly effective vaccination program.

Officials at the Centers for Disease Control and Prevention said the majority of people diagnosed with measles this year were unvaccinated.

“This outbreak is pretty eye-opening for all of us,” said Nicole Cavenagh, a pediatric neuropsychologist and director of the Touro University Nevada Center for Autism and Developmental Disabilities. “We are seeing this pop up as a result of parents not vaccinating.”

Why would parents choose not to immunize their children?

The anti-vax movement gained a foothold after British doctor Andrew Wakefield published a report in 1998 linking the measles, mumps and rubella (MMR) vaccine to autism. Parents looking for causes for their children’s autism, celebrities and bloggers latched on to the study and vigorously backed its findings. But concerns about its validity mounted, and the medical journal that published the report formally retracted it.

Scientists, researchers, doctors and public health organizations agree: Vaccines do not cause autism.

Still, some parents fear immunization. They continue to insist, despite the science, that vaccines cause autism. They say the shots contain mercury and heavy metals; cause the diseases they are trying to prevent; don’t work; are symptomatic of an overly obtrusive and controlling government; are pushed by pharmaceutical companies that pay doctors to promote them; or are unnecessary because people can build up natural immunities to diseases.

In fact, with the exception of a few flu vaccines, immunizations don’t contain mercury or heavy metals. They don’t infect people with the disease being prevented as hardly any childhood vaccines contain live virus, and it is impossible to get sick from a dead virus. Pharmaceutical companies don’t pay doctors to immunize children, and vaccines have been proven to be safe and effective, which is why doctors recommend them.

So far this year — and it’s not even March — Clark County has confirmed six cases of measles in Southern Nevada, two more than seen in the dozen-year span from 2003 through 2014.

The people diagnosed include an infant, a young child who received a single dose of vaccine, a Valley High School student who was fully vaccinated, an unvaccinated adult, an undervaccinated adult and an adult whose immunization status is unclear.

Nevada health officials have hesitated to label the incidents an outbreak but acknowledge the situation marks an abrupt shift from the past decade.

Epidemiologists believe the Disneyland case originated with a tourist who brought measles to California from outside the country. In many nations, measles is abundant; it remains one of the leading causes of death among young children worldwide. Past U.S. epidemics have been linked to Americans traveling to England, France, Germany, India, the Philippines and Vietnam.

In a vaccinated population, a hitchhiking virus does little harm. If enough people are immunized, vaccines offer a community benefit known as herd immunity. There’s little opportunity for an outbreak. Even people who can’t be immunized — infants, pregnant women and people with compromised immune systems, for instance — get some protection because the spread of the disease is contained.

Unvaccinated people poke holes in that net of protection. The more gaps in immunity, the more chance for an outbreak.

“If (the anti-vaccination movement) grows, you could start to see problems like this all the time,” said Brian Labus, senior epidemiologist for the Southern Nevada Health District.

Heidi Parker, executive director of Immunize Nevada, a state coalition that advocates for vaccinations, said the measles cases should be considered a call to action.

“The majority of parents do believe in vaccination,” Parker said. But “there’s that small (percentage) that’s not vaccinating, and we want them to understand the facts.”

Nevada’s immunization rate has long lagged below the national average. It has been increasing but not as fast as the rest of the nation.

In 2013, two-thirds of Nevada children ages 19 through 35 months were up to date on all of their various recommended vaccinations, the CDC found. That was up 1 percent from 2012 but far below the national average of 73 percent.

Nevada’s vaccination rate for measles specifically was much higher. Nevada’s MMR immunization rate for children ages 19 through 35 months was 90.4 percent in 2013, just shy of the national average of 91.9 percent. California’s MMR vaccination rate was about the same, 90.7 percent.

Health officials said Nevada’s lower immunization rate isn’t necessarily indicative of a strong anti-vaccination movement, as it is in, say, California. Rather, “I think a lot of our barriers to vaccination are access issues and insurance,” said Richard Cichy, community health nurse manager for the Southern Nevada Health District.

Cichy pointed to Nevada’s doctor shortage as one barrier. A study by University of Nevada School of Medicine researchers found Nevada has the 46th-lowest rate of pediatricians and family practice doctors in the country.

Nevada also has a historically high rate of uninsured residents. County health officials hope the Affordable Care Act helps boost Nevada’s immunization rate as more people become insured.

To address the lackluster vaccination rate, the Clark County health district started auditing immunization rates at preschools and day cares to see if children were falling through the cracks, either by not being vaccinated or by not being up to date on recommended shots. Seventy-four percent of children ages 19 months to 5 years old were current with vaccinations in 2013. When a re-audit was done several months later, the immunization rate had jumped to 92 percent. Outreach efforts had worked.

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Nevada law allows for medical exemptions for vaccines — for instance, if a child has a compromised immune system and could be harmed by the immunization. The state also offers religious exemptions for school-age children. Unlike California, Nevada doesn’t have a personal belief exemption, but health officials admit the rules are fuzzy because parents can easily claim religious exemption instead. They just need to submit a written statement to school officials.

Clark County School District officials said 1.1 percent of students haven’t been fully vaccinated against measles. Of those students, 0.4 percent have religious exemptions, and the remaining 0.7 percent are noncompliant, meaning they haven’t received the full MMR immunization series or their paperwork hasn’t been processed, schools spokeswoman Melinda Malone said.

School district nurses reach out to parents when they realize a child is unvaccinated or undervaccinated.

“Sometimes parents are really diligent,” Malone said. “Sometimes they’re not.”

The CDC recommends children receive two doses of the MMR vaccine, the first between 12 and 15 months and the second between ages 4 and 6. Combined, MMR doses are about 97 percent effective in preventing measles.

“Vaccinations aren’t perfect,” said Duddy, chief of pediatrics at MountainView Hospital. “Well, neither are seat belts. Not everyone who wears a seat belt survives a crash, but is it unwise to wear seat belts?”

Parents whose children are being put at risk by anti-vaxxers are mad at what they see as parental — and societal — irresponsibility. And they aren’t keeping quiet.

Jennifer Hibben-White and her 15-day-old son were exposed to measles in a Toronto doctor’s office while waiting for a weigh-in appointment for the newborn. Baby Griffin was too young to be vaccinated. Hibben-White had already lost one daughter unexpectedly, to a blood infection.

“I’m angry. Angry as hell,” Hibben-White wrote in a Feb. 10 Facebook post that received international attention. “I won’t get angry at or blame the person in the waiting room. I would have likely done the same thing ... you get sick, you go to the doctor. I have no idea what their story is and I will never know. But I do know one thing: If you have chosen to not vaccinate yourself or your child, I blame you. ... I watch these arguments trotted out on Facebook and Twitter citing false science and long discredited ‘studies’ that just won’t stop and Jenny McCarthy quotes and ‘it’s MY choice’ to not vaccinate ... and I think ... what would you have done if your child lay dying? Would you give them a scientifically proven, safe and effective vaccine and risk the minuscule likelihood of a side effect? Or would you let them go, knowing that at least they won’t develop autism (which they wouldn’t even develop anyway because SCIENCE)?”

Dr. Timothy Jacks, an Arizona pediatrician, testified before Congress about the importance of vaccines the same day, after an open letter he wrote to the parents of an unvaccinated child who exposed his family to measles went viral. Jacks’ 10-month-old son Eli is too young to be vaccinated and his 2-year-old daughter Maggie has leukemia and can’t be immunized because she is immunocompromised. The family was exposed at a clinic while waiting for a lab draw after a round of Maggie’s chemotherapy.

“Unvaccinating parent, thanks for screwing up our three-week ‘vacation’ from chemotherapy,” Jacks wrote. “Instead of a break, we get to watch for measles symptoms and pray for no fevers (or back to the hospital we go). Thanks for making us cancel our trip to the snow this year. Maggie really wanted to see snow, but we will not risk exposing anyone else. On that note, thanks for exposing 195 children to an illness considered ‘eliminated’ from the U.S. Your poor choices don’t just affect your child. They affect my family and many more like us. Please forgive my sarcasm. I am upset and just a little bit scared.”

A national survey this month by the Pew Research Center found the majority of Americans — 83 percent — believe the MMR vaccine is safe. Seven percent said they were unsure, and 9 percent said the vaccine is dangerous.

The latter group irks Duddy to no end.

“People who don’t vaccinate — I feel like I should confiscate their keys and issue them a horse,” Duddy said. “It’s very, very frustrating.”