Measles Vaccination: Why Ohio Must Step it Up

The United States experienced a record measles year in 2014, with 644 cases from 27 states reported to the U.S. Centers for Disease Control and Prevention.  This was the highest number of cases since measles elimination was documented in America in 2000, and 341 of the cases, more than half, were from Ohio.  So far in 2015, there have been 154 cases in 17 states, with 77 percent of cases part of a large, ongoing multi-state outbreak linked to exposure to an unvaccinated female traveler in her 20s at Disneyland.

While time will tell whether Ohio will be spared this year, there’s no state in the nation with fewer toddlers protected against measles, mumps and rubella (MMR).  The CDC says that in 2013, only 86 percent of Ohio’s 19- to 35-month-old children were vaccinated, compared to rates of 96 percent or higher in top states.  Ohio has been among the only states in the nation not requiring vaccines for entering licensed daycare, a situation which will be remedied by a new law taking effect this month.
“We could be primed for an outbreak if measles does hit the state,” observes Tara C. Smith, PhD, associate professor, epidemiology, and infectious disease expert.  “If we got an outbreak in Cleveland or one of the suburbs, we could be in bad shape,” she says.
“National statistics tend to obscure local trends,” says Smith.  “The small percentage that aren’t vaccinated aren’t randomly distributed.  Instead, they tend to cluster, with many unvaccinated children living in close proximity to others, creating anti-vaccine communities with high susceptibility to measles and other vaccine-preventable diseases,” she says.  “This is where we see explosive outbreaks, such as Ohio’s 2014 measles outbreak, which was in our Amish community,” she observes.  Smith cites poverty-driven lack of access to vaccines, as well as vaccination resistance related to fear of autism, as contributing to measles concerns in Ohio.  
By school age, Ohio’s child vaccinate rates improve.  And the new state law requiring children entering licensed daycare to be vaccinated should improve toddler protection numbers.  But “Ohio as a whole doesn’t require immunization of college students,” Smith observes, adding that Kent State requires the MMR.  And Ohio’s daycare and school vaccine laws allow for exemptions in cases in which parents object or there are medical reasons.
“Parents who don’t vaccinate their own children not only place them at risk, but potentially put others in the community at risk, especially infants under age one, children and adults with weak immune systems and people with cancer,” Smith says.  "The diseases are much worse than any potential side effect from the vaccines,” she says.  Complications from measles include pneumonia and brain infection, and it’s the leading cause of childhood blindness globally.
Smith was recently interviewed by CNN on measles vaccination and is active daily on social media, arguing for vaccination.  “The World Health Organization calls vaccines one of the most important public health inventions ever,” she declares.  “But right now, there’s a lot of controversy and misinformation, perpetuated by and adding strength to the anti-vaccine movement,” she says.  Calling for those in public health to step up their game, “the more accurate science-based information that’s out there, the better,” she says.
“Before the measles vaccine was available, the United States saw approximately four million cases each year and 400 to 500 deaths,” Smith details.  “These are the stats that vaccine-deniers tend to emphasize – a low number of deaths compared with number of infections.  However, those stats ignore that nearly 48,000 people were hospitalized each year because of measles and its complications.  One in 20 developed pneumonia.  More rarely, but more seriously, 1,000 became chronically disabled due to measles-related encephalitis,” she says.
“Many also forget that we had a massive U.S. measles outbreak in 1989-91,” she continues.  While 644 U.S. cases in 2014 seems high compared with recent years, 25 years ago, measles incidence spiked to 18,000 cases per year, with a total of more than 55,000 infections before the outbreak began to dwindle.  It was the largest measles outbreak in this country since the 1970s,” she says.
In fact, more than 300 Kent State students came down with measles in the spring of 1989, out of a total 661 Ohio cases.  According to the CDC, Kent State and Texas Tech University were the two largest collegiate measles outbreaks that year.  Many stricken students had received one vaccination during childhood, but did not develop sufficient immunity.  Today, a two-dose series is the recommended standard.
“Ohio’s Amish were not vaccinated due to fear of an adverse event.  One child had a bad MMR reaction many years ago, which scared off the entire community.  But during last year’s outbreak, many got up to date on their vaccines.  Some 10,000 shots were given in a month or so,” she recalls.  
“Living in the United States does not magically protect you from dying from measles or other infectious diseases,” Smith warns.  “Being generally healthy alone is not a guarantee against hospitalization from a measles infection.  The best defense is an up-to-date MMR vaccine, ensuring that those living near you and going to school with you are likewise vaccinated and spreading the word that vaccines are safe and life-saving,” she counsels.  “The best way to respect measles is to acknowledge its potential to cause serious illness."