What Does The Anti-Vaccination Movement Mean For Cincinnati?

Local docs talk measles risk, alternate schedules, and the “magic number” for immunity.

While January’s Disneyland-linked measles outbreak brought national attention to anti-vaccination parents, Ohio families have long had reason to follow this issue.

In the spring of 2014, two Amish missionaries from Knox County, just north of Columbus, unwittingly contracted measles while in the Philippines. Upon returning home and being incorrectly diagnosed at a local hospital, they spread the disease within their community, many members of which had not been vaccinated. Three hundred eighty-three individuals fell ill, nearly four times the number linked to the Disneyland outbreak.

Chances are, you didn’t hear about it. What happens in an isolated community doesn’t seem as threatening as what happens in The Happiest Place On Earth. But we’re talking about a disease so contagious that there’s a 90 percent contraction rate for unvaccinated people who come into contact with someone who is incubating the virus. Every outbreak should sound an alarm bell.

“The further we get away from measles, the fewer physicians have a lot of experience with it,” says Dr. Beverly Connelly, director of the Infection Control Program at Cincinnati Children’s Hospital. Connelly, a “preventionist at heart,” remembers a childhood where a fear of measles and other diseases (now largely absent from the population due to vaccinations) was still very real. “The reason we don’t see these diseases widely is because we maintain our vaccination rates,” Connelly explains. “We live in a very mobile world. If we let our guard down, someone will bring these diseases in.”

Measles was declared eliminated in the United States in 2000, meaning only those who traveled to places where the disease was still endemic were at risk of exposure. But in 2014, there were 644 reported cases—more than in the previous five years combined. As of late March of this year, there have been 178 confirmed cases, many of them attributed to the Disneyland incident but others to unrelated outbreaks in Illinois, Nevada, and Washington.

In 1998, surgeon and medical researcher Andrew Wakefield published a paper in The Lancet, a highly respected and peer-reviewed medical journal, suggesting a link between the MMR vaccine, which protects against measles, mumps, and rubella, and the onset of autism. While the paper was received with guarded interest by the scientific community, vaccination rates began to decline both in the UK and in the United States after Wakefield toured autism conferences and, in 2000, appeared on 60 Minutes. But in 2004, after an extensive investigation, the Sunday Times of London revealed that Wakefield was a fraud: he had been paid more than $750,000 over the course of his research to fabricate the evidence.  It took 12 years and many hundreds of thousands of research dollars—including studies from the Centers for Disease Control and Prevention and the American Academy of Pediatrics, among others—to discredit Wakefield’s claims. The paper was fully retracted in 2010, but the damage had been done. With symptoms presenting themselves around the same time as the MMR vaccine is routinely administered, parents who wanted answers for their children’s diagnoses finally felt like they had them. Celebrities, most notably Jenny McCarthy, brought further attention to the issue, citing the study as evidence and promoting a culture of distrust around a branch of medicine that had been, until that point, largely considered to be the most innocuous form of preventative care available.

“Our parents didn’t care if there was a little bit of aluminum in the vaccine; they didn’t want to see their kid in a wheelchair,” says Dr. Jeff Drasnin of Cincinnati’s ESD Pediatric Group, highlighting the inability of our generation to really understand the fear of diseases like polio, which killed more than 3,000 children and left more than 21,000 with mild to disabling paralysis during its largest outbreak in 1952. “We haven’t seen these diseases in their glory. We’re not afraid of the diseases; we’re afraid of the vaccines.”

Drasnin is “the local guy” to see if you’re considering an alternative vaccination schedule or choosing not to vaccinate at all. He estimates the number of local non-vaccinating families who receive care at ESD to be less than 5 percent, but still expects that’s the largest percentage in the city.

“I fully support full vaccination and have vaccinated my own children per prevailing recommendations from the AAP, Advisory Committee on Immunization Practice, and Centers for Disease Control,” Drasnin wrote in 2013. “The majority of my group practice is still made up of more traditional families who follow most vaccine recommendations without significant discussion.”

But Drasnin actually relishes the discussion and the opportunities it provides to really connect with and educate local families.

“I encourage people to ask questions,” he says. “One of the coolest things about my career is that I get to listen to people, engage with them. And sometimes, they’ll change their mind.”

But what happens when they don’t?

“My biggest fear as a pediatrician is that people will listen to the noisy voices that aren’t necessarily in their child’s best interest,” says Connelly. Citing the lethal risks for infants and the elderly, as well as for those individuals whose immune systems are too compromised to receive vaccinations, Connelly stresses the importance of “the magic number:” 80 percent.

“If you look at something likes measles, once the vaccination rate gets above 80 percent, instances of the disease just plummet,” she explains.

Diseases like measles cannot take hold in a population that has above 80 percent immunity, which is critical, because even individuals who have received the full round of vaccinations are still at risk. Thirteen of the 133 individuals who contracted measles from the Disneyland-linked outbreak had received at least one dose of the MMR vaccine.

When asked about the strength of natural immunity versus vaccinated immunity—after two MMR vaccinations, one at 15 to 18 months of age and again between the ages of 3 and 4, individuals are between 95 and 98 percent immune. And as for the trend of parents organizing “Measles parties” to expose their children, Connelly was frank:

“It’s true that natural immunity is good stuff, but why would I give somebody a potentially life threatening illness to get them immune when I can just give them a vaccine?” Connelly asks. “Why would I take that chance? Measles is not an innocuous childhood illness. It is a significant illness that has significant consequences.”

Until recently, it was estimated that only 66.8 percent of Ohio’s most vulnerable population—very young children—had received the combined vaccine series, which includes MMR. For anyone who’s ever set foot in a child care program, this is a troubling statistic. Especially when you consider that 32.9 percent of children under the age of five spend at least part of their week in the care of someone besides a parent.

Getting families in the door and providing quality primary care is Drasnin’s passion, and he regards the recent outbreak as a teachable moment.

“I don’t think you legislate that; I think you educate that.”

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