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Measles Outbreak Exemptions

A sign prohibiting all children under 12 and unvaccinated adults stands at the entrance to PeaceHealth Southwest Medical Center on Feb 4 in Vancouver, Wash. A measles outbreak that has sickened more than 40 people in the Pacific Northwest has prompted a call to eliminate a "philosophical" vaccine exemption that's resulted in 4 percent of children in Washington state to attend school without their routine childhood shots.

As I write this, there are about 50 confirmed cases of measles in Washington state, and smaller outbreaks elsewhere. Remarkable, for a disease declared no longer endemic by 2000 in the United States.

How? Two key factors: First, the world has become “smaller” — in hours, one can easily travel around the world, carrying an infection that may not yet be symptomatic. The health and well-being of the world directly affects our own country’s public health.

Second, a strident movement of those opposed to immunizations has almost professionalized the spreading of deeply incorrect information, outdated speculations, and rather egregious misrepresentations of risk — calculated to seed doubt, sow fear and frighten parents. In an era where many have been shocked by the viciousness of those who cry “Fake News,” pediatricians have wearily noted that we’ve heard these same tactics for years now from the anti-vaccination proponents.

To be fair, the majority of parents who raise questions with their health care providers do not fall into this camp — they are vaccine-hesitant, asking out of concern, fear and a desire to make the best possible choice for their children; but notably, they are still willing to listen. I’ve always responded to genuine questions by listening carefully, acknowledging the strength of their worries, and then offering clear, calm, factual information, reminding them that we both have the same goal: to keep their child healthy and safe. Parents I speak with appreciate this, and virtually all choose to immunize their children fully and on schedule.

What always stuns me are the sheer range of tactics and vitriol used online by the fervent anti-vaccination groups in an effort to confuse and bewilder. Most recently, many eschew even the pretense of scientific fact and simply minimize disease — “It’s only measles, it’s not that bad.” Certainly, many children contracted measles before immunizations were available for it, but complications were not minor. We’ve been so successful at preventing measles via immunization that it’s easy to forget what it could do.

I thought I’d let noted children’s author Roald Dahl (“Charlie and the Chocolate Factory,” “James and the Giant Peach” and many more) remind us. He wrote this touching, beautiful piece 24 years after his daughter’s death from complications of measles.

'Olivia, my eldest daughter, caught measles when she was 7 years old. As the illness took its usual course, I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“'Are you feeling all right?' I asked her.

“'I feel all sleepy,'” she said.

"In an hour, she was unconscious. In 12 hours she was dead.

"The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her."

He goes on to say that this would have been preventable had reliable immunization been available at that time, and ends with this heartfelt plea to parents who may hesitate to do so:

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"So what about the risks that your children will run from being immunised?

"They are almost non-existent. … I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.

"So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised."

Thirty-three years later, we’re still fighting this battle. Let his words remind us of the human toll of vaccine-preventable diseases. It comes down to this: Vaccines work; vaccines are safe; vaccines save lives.

And most notably: Vaccines cause adults.

Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health and also holds master’s degrees in public health and children’s librarianship. Engaged in primary care pediatrics, early literacy, medical education, and advocacy, he covers a variety of topics related to the health and well-being of children and families.

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