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A measles outbreak has sickened at least 41 kids and young adults in Clark County, Washington, along with a man from the Seattle area and someone in Oregon. One person has been hospitalized, and the governor of Washington has declared a state of emergency.
So far, none of the patients whose immunization status has been confirmed got their measles vaccination.
It wasn't always this way. State records in Washington show that during the 2004-05 school year, vaccination rates for kindergartners in Clark County were above 91%. But during the 2017-18 school year, Clark County youngsters entering kindergarten had an immunization rate of 76.5%.
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Back in that 2004 school year, the vaccination rate was "getting close" to a threshold for herd immunity (around 95%), Clark County public health director Alan Melnick told Business Insider.
Herd immunity is a level of vaccination at which people who can't safely get vaccines (because they have HIV, cancer, or other conditions which make their immune systems more fragile) are protected. When enough people around them are immunized, they can live within a kind of protective tribe of disease-free people, and are thus relatively "immune" to illnesses like measles.
But over the last decade, more and more people have been taking advantage of laws in Washington state that allow just about anybody to go to school without their shots for personal or philosophical reasons. Many of those parents are part of a growing movement of "anti-vaxxers" who worry about the safety of vaccines.
"My belief is that they have gone down because of all the misinformation going around," Melnick said of the county's vaccination rates.
Opposition to vaccines is generally based on junk science that has been endorsed by celebrities like Jenny McCarthy who, with Oprah's help, falsely hinted that there may be something dangerous about the measles vaccine. Melnick said one need look no further than his county's official Facebook page to glimpse the rampant (and at times sophisticated) anti-vaccine propaganda that's spreading around the area.
Before the introduction of measles vaccines in the early 1960s, just about every kid got the illness. Some anti-vaxxers wrongly assert that we'd all be healthier today if we continued to get measles. They've even suggested "measles parties."
Getting the measles used to be a rite of passage for children — between 95% and 98% of children got it by their 18th birthday.
Before the vaccine was introduced, some parents tried to get their kids sick with the measles when they were young, since a case of the measles can be more severe when you're an adult (like chicken pox or shingles).
But even a run-of-the-mill measles case can be torturous. Melnick remembered having it himself as a young child.
"You're miserable with measles. We're talking about high fever, we're talking about being sick for at least a week," he said. "I remember being in bed for a long period of time with the blinds closed, because when you get those red eyes, you get what's called photophobia." (That's a sensitivity to light.)
Kids who are younger than 5 and adults over 20 are more likely to develop measles complications; some of the most common include ear infections and diarrhea.
"Even without complications, it is not very pleasant," Melnick added. "I wouldn't wish it on my worst enemy."
Studies show that babies who get the measles very young have lower mean weights than other infants, which suggests that contracting the virus may have a lasting effect on growth.
Unfortunately, a discredited doctor named Andrew Wakefield has led many people to mistakenly believe that there's a link between autism and the measles vaccine.
Wakefield's research on autism and vaccines has been discredited. His main paper on the subject has been retracted, and other studies since have found no link between autism and vaccines.
One investigation suggested that part of Wakefield's motivation was money.
Wakefield once "proposed starting a company that could reap huge returns from molecular viral diagnostic tests," journalist Brian Deer found in an investigation published in the BMJ. The scheme "predicted a turnover from Britain and America of up to £72.5m a year," he said.
Measles killed more than 400 kids every year in the US before a vaccine was invented. By contrast, the most recent measles death in the US was one adult case in 2015.
The CDC estimated that from 1994 to 2013, vaccines prevented more than 70,000 measles cases in the US, including over 8,800 hospitalizations and more than 57 deaths.
The last known measles death in the US was a Washington woman with a compromised immune system who died in 2015 from pneumonia that resulted from measles. She's an example of one of the few people who shouldn’t get the vaccine, and she's an example of someone who's at risk when there's no herd immunity.
Anti-vaxxers sometimes suggest that because the measles is a live virus, the vaccine will make a person who gets the shot contagious. This is not true.
The measles vaccine is a weakened version of the live virus, and you're not contagious after getting the shot. You may have some mild reactive symptoms like a sore arm, rash at the injection site, or a slight fever, but this is your body building up its immunity.
Kids who get infected with the measles, on the other hand, can shed the virus for several weeks after their infection is over, thereby transmitting the illness to others. Infected people also may not know that they're sick right away, since the initial symptoms are similar to the common cold (runny nose, cough, fever, and pink eyes).
"You can have those for several days before the rash starts, and you're contagious for that period," Melnick said.
The measles can also hang out in the air for two hours after a contagious person has left a room.
Vaccine opponents often argue that drug companies just sell vaccines to make money. Actually, they'd make more money if they didn't offer vaccines.
Vaccines, which cost an average of about $12 a pop, provide cheap protection against common illnesses. Unlike the drugs we take when something goes wrong, a vaccine dose (or two) usually lasts a lifetime.
That's not a great money-making strategy for Big Pharma.
"By itself, Lipitor, an anti-cholesterol drug, brings in more revenue — about $12 billion this year — than the entire vaccine market,” The Wall Street Journal reported in 2005.
Every dollar spent on a measles, mumps, rubella vaccine (MMR) saves an estimated $14-26 in healthcare costs, including both the direct costs of caring for sick kids and the larger socioeconomic effects.
Some who rail against vaccines worry that a measles vaccine could cause kids to get more seizures. Again, not true: Febrile seizures are often triggered by fevers, and more measles cases means more fevers overall.
"Any child with a fever can get what's called a febrile seizure," Melnick said. These baby spasms are "horrible" to watch, he added, but typically benign.
"The disease causes a lot more fever than the vaccine ever does or ever will," he said.
The same is true of encephalitis: It's far more common to experience brain swelling because of the measles than from the vaccine.
Other severe (and rare) complications from measles can affect every organ system in the body.
Death from measles is rare, but problems can include pneumonia, croup, seizures, appendicitis, hepatitis, corneal scarring, blindness, and renal failure.
Melnick also said that some anti-vaxxers express concerns that the measles vaccine contains mercury. It does not.
"The mercury in there is not the kind that causes a neurologic problem," Melnick explained. "It's not in the measles vaccine, anyway."
Some parents who don't vaccinate their kids think measles wouldn't be a problem if people just got enough Vitamin A. This conflates the issue of malnutrition with vaccination.
Being Vitamin A deficient makes it tougher for the body to fight all kinds of infections, including the measles. But Vitamin A does not prevent measles.
Generally speaking, when your health is better and you have access to better food and nutrition, you'll handle the measles better and suffer fewer complications. Even before a vaccine was developed, the death rate from measles in the US plummeted in the first half of the 20th century, from 25 deaths per 1,000 cases to just 1 per 1,000. That's because more people in the US became well-fed and transitioned to less crowded living conditions.
But that doesn't mean we've developed natural immunity or that we should treat the measles as no big deal.
"People become complacent because they don't realize how bad it can be," Melnick said. "And that's what scares me the most."
Some anti-vaxxers wrongly suggest that people have died from the measles vaccine.
For this flawed argument, anti-vaxxers often point to a federal database (VAERS) maintained by the CDC. However, the VAERS database makes it clear that a report of a death after a vaccine administration doesn't necessarily mean the vaccine is what caused the death.
What's more, a wealth of evidence from decades of vaccine administration around the world suggests that deaths don't occur in otherwise healthy children and adults who get a measles vaccine.
It's true, however, that there have been a few cases in which someone has died after getting a vaccine. The causes include severe allergic reactions (which can be treated by a clinician if a shot is administered in a clinic) and severe immunodeficiencies.
Many assert that not vaccinating their children is a personal matter. But vaccinations actually protect others from illness too, especially kids like Rhett Krawitt (shown below) who can't get shots because their immune systems are too vulnerable.
"I respect people’s choices about what to do with their kids, but if someone’s kid gets sick and gets my kid sick, too, that’s a problem," Krawitt's father, Carl Krawitt, told The New York Times in 2015, in the midst of a measles outbreak in nearby Orange County.
Some parents of vaccinated kids in the Pacific Northwest say they might keep their youngsters home from school until the threat is over. That's not really necessary, as the vaccine is 93% effective after the first dose, and 97% after the second.
"About three out of 100 people who get two doses of MMR vaccine will get measles if exposed to the virus," the CDC says.
Luckily, those few unlucky cases will be milder, and those people are also less likely to spread measles to other people.
Anti-vaxxers are a tiny but vocal minority.
In 2015, the Pew Research Center polled more than 1,000 Americans and found that 83% believe the measles vaccine is safe. Younger adults were more likely to say that parents should get to choose whether or not their kids get immunized.
In other areas of the world, that's not the case — families are clamoring to get their kids shots.
Since 2000, measles vaccine campaigns around the world have "contributed to an 87% decrease in reported measles incidence and an 84% reduction in estimated measles mortality" and prevented 20.4 million deaths, the CDC reported in 2017.