When Adults Choose Not To Vaccinate Against Measles, Babies Pay The Price

Anna Almendrala

When adults choose not to vaccinate themselves or their children against measles, it’s babies and toddlers who suffer most.

In a new analysis of all measles cases from 2001 to 2015, researchers from the U.S. Centers for Disease Control and Prevention found that while the disease is rare in the U.S., measles is most common among babies and toddlers. There were more than five cases per million people among children under 15 months, compared to less than one case per million people in the general population.

Specifically, beginning at 16 months, measles rates began declining as people got older. In total, there were 1,789 recorded measles cases in the U.S. from 2001 to 2015.

“Even if [a measles outbreak] starts among school-aged kids or another population, ultimately babies get hit the hardest,” said Dr. Peter Hotez, a pediatric vaccine expert and dean of the National School of Tropical Medicine at Baylor College of Medicine, who was not involved in the research. “You worry about measles because it’s lethal and because it can cause permanent neurological impairment.”

There’s a clear explanation for why those under 15 months are most affected: The typical age for a first MMR vaccine is between 12 and 15 months old, as babies are too young and weak to get inoculated. In addition to being more at risk of measles for lack of a vaccine, babies are also more vulnerable to the disease because it affects children more severely. When young children get the measles, they’re more likely to be hospitalized, die, or end up with pneumonia, hearing loss or lifelong brain damage.

Measles is one of the most infectious viruses we know of because it can spread in the air, through a person’s coughs or sneezes. If one person gets the illness, 90 percent of unvaccinated people around him or her will also get the disease, which can result in rash, fever, sore throat and a runny nose. Two doses of the measles vaccine (in the bundled measles, mumps and rubella shot) protect a person from measles with an effectiveness rate of 97 percent.

Endemic measles was eliminated in the U.S. in 2000, but the highly contagious virus continues to bloom sporadically in the U.S., breaking out in communities with low vaccination rates. Typically, what will happen is that a person from another country brings measles to the U.S., Hotez explained. If they happen to land in an area with strong vaccination rates, the virus stops with that traveler. But if they stay in a community with low vaccination rates, the virus gets the chance to spread beyond the initial person.

This appears to be what happened during the 2017 measles outbreak in Minneapolis. While rates of vaccination are generally high there, a pocket of low vaccination rates among the Somali immigrant community allowed the virus to flourish, resulting in the infection of 79 people, 22 of whom were hospitalized. Almost all of the cases were in children under 10 years old, and 71 of the measles patients had not been vaccinated.

In 2015, the measles virus spread through Disneyland in Anaheim, California, infecting 111 people. Wealthy communities in Southern California had seen declining vaccination rates before then, which may have allowed the virus to spread more easily through the park. In response to the outbreak, state officials removed the state’s personal belief exemption for vaccines in children.

These “hot spots” of low vaccination rates are where we can expect to see more measles outbreaks in the future, Hotez said. Washington state, Oregon, Texas and Idaho are at particularly acute risk of a measles outbreak, he said, in part because they are among the 18 states that allow parents to opt out of vaccines for their children for non-medical reasons.

“My concern is that the frequency and magnitude of these outbreaks will continue to increase to the point where maybe one day we’ll no longer be able to say measles has been eliminated in the U.S.,” Hotez said. “It would be a tragic reversible of global goals for sustainable development.”

Before the measles vaccine arrived in the U.S. in 1963, about 3 to 4 million Americans got the virus every year. An estimated 400 to 500 people ― mostly children ― died of the disease each year, 48,000 were hospitalized for it and 4,000 suffered swelling of the brain as a result of measles.

Before GAVI, a global vaccine alliance, was formed in 2000, more than 750,000 children died every year from the disease. That number has fallen by 79 percent, but poor countries still struggle to get universal vaccine coverage. And in rich countries like the U.S., cases have begun to tick up because of the backsliding on vaccination rates.

Measles also appears to be surging again in Europe thanks to poor vaccination rates. Since June 2016, Italian officials have recorded more than 3,300 cases of the virus, while Romania had almost 4,000 cases.

“When measles outbreaks occur, being unvaccinated ― rather than failure of vaccine performance ― is the main driver of measles spread,” CDC researcher Nakia Clemmons said. “The best protection against measles is MMR vaccine.”

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Hepatitis B

Your newborn should get this shot even before leaving the hospital, and receive another dose at one to two months and a third at six to 18 months. The vaccine protects against an incurable, liver-infecting virus, hepatitis B, which can be passed to a baby during childbirth if the mother is infected. This virus spreads through contact with blood or other body fluids (sharing toothbrushes and utensils can put you at risk). Soreness at the site of the shot, or a slight fever, is the most common side effect, according to Gabrielle Gold-Von Simson, M.D., associate professor of pediatrics at NYU Langone Medical Center in New York.

DTaP

The DTaP vaccine protects against diphtheria (a germ that can form a gray or black film in the throat), tetanus (an infection that can cause muscle spasms so strong they can break bones), and pertussis (a highly contagious disease that causes a severe, uncontrollable cough, known as whooping cough). Five vaccine doses are given to children at two months, four months, six months, 15 to 18 months and four to six years. (And boosters at age 11 or 12 and then every 10 years.) DTaP may be combined with other vaccinations to reduce the number of shots needed. "Now, it's DTaP with hepatitis B and the polio vaccine. So, it's five in one," Dr. Gold-Von Simson says.

MMR

This combo shot protects against three viruses: measles (which causes high fever and a body-wide rash); mumps (which causes face pain, swelling of the salivary glands, and sometimes scrotal swelling in boys); and rubella or German measles (which can cause birth defects if the infection occurs during pregnancy). The first shot is given at 12 to 15 months of age and once again between the ages of four and six. MMR is sometimes combined with the chickenpox vaccine into one shot (brand name ProQuad). "All these different preparations are designed to reduce the amount of shots the pediatrician has to give," says Dr. Gold-Von Simson.

Chickenpox

Chickenpox, a highly contagious rash that many people remember from childhood, is caused by the varicella virus. A varicella vaccine was first licensed in 1995 and now spares future generations this itchy misery. Chickenpox infections can be especially dangerous in adults who don't have immunity from the vaccine or haven't had it in childhood, and can also lead to shingles, an extremely painful blistering rash. The shot is given to children at 12 to 15 months and again between four and six years. The vaccine can cause soreness at the site of the shot, fever, and, in some cases, a mild rash.

Haemophilus Influenza Type B (Hib)

"Haemophilus influenza type b is the bacterium that causes meningitis," says Dr. Gold-Von Simson. Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, is particularly dangerous for kids under the age of five. Hib vaccines are generally given at two, four, six, and 12 to 15 months of age. Depending on the vaccine used, the six-month shot may not be needed. Fever, swelling, and redness at the site of the shot are potential side effects.

Polio (IPV)

Polio vaccine is "such a success," says Dr. Gold-Von Simson. "Because of the vaccine, there are no more cases [of polio]." There are no more in the United States that is. The virus hasn't been eradicated worldwide, so kids still get the IPV, or inactivated polio vaccine, which is a shot containing killed virus. Polio is bad news, and can cause paralysis and even death. Children are given the IPV at two months, four months, between six to 18 months, and then again between the ages of four and six years.

Pneumococcal Conjugate (PCV)

This vaccine, known as PCV13 (brand name Prevnar), protects against 13 types of Streptococcus pneumoniae, which are bacteria that can cause all sorts of mayhem, including meningitis, pneumonia, ear infections, blood infections, and even death. A total of four shots are given to kids (at two, four, six, and 12 to 15 months of age) to protect them against the germs, known collectively as pneumococcal bacteria. The most common side effects of the vaccine include drowsiness, swelling at the site of the shot, mild fever, and irritability.

Influenza (flu)

Flu vaccinations are given each year starting in the fall. The Centers for Disease Control and Prevention recommends them for kids ages six months or older, although they aren't required for school attendance. (Connecticut and New Jersey require the vaccine for attending child-care centers and preschool.) Common side effects from the vaccine include soreness, redness, or swelling at the site of the shot. Fever and aches may occur too. "If you have an egg allergy, you shouldn't have the influenza vaccine," says Dr. Gold-Von Simson.

Rotavirus (RV)

The rotavirus vaccine (RV) (brand names RotaTeq, Rotarix) is given to children at two and four months of age. (RotaTeq is also given at six months.) The vaccine protects against a virus that is the most common cause of severe diarrhea and vomiting in young kids worldwide. About 55,000 children in the U.S. were hospitalized each year due to rotavirus before the vaccine was licensed in 2006. It is not required for school attendance. The vaccine is in liquid form and given by mouth to babies. It may make them a bit more irritable and can also cause mild diarrhea or vomiting.

Hepatitis A

Kids can catch hepatitis A from sharing food or drinks or by putting contaminated food or objects in their mouths. It's a viral infection that affects the liver, and can cause a number of symptoms, including fever, tiredness, jaundice, and loss of appetite. Children ages 12 through 23 months generally get two doses of the Hep A vaccine, with a minimum interval of six months between shots. Some states require the vaccine for school attendance. Soreness where the shot was given, headache, and loss of appetite are the most common side effects of the vaccine.

Meningococcal Conjugate (MCV4)

This vaccine, known as MCV4 (brand name Menactra), protects against meningococcal bacteria, which can infect the membranes surrounding the brain and spinal cord. MCV4 is recommended for kids at 11 or 12 years of age, and anyone between ages two and 55 who is at increased risk of infection (people with certain health conditions, military recruits). Teens starting college should be vaccinated with MCV4 before going to school if they didn't previously get the shot. (Freshman living in dorms are at increased risk of infection.) A little pain at the site of the shot is the most common side effect.

Human Papillomavirus (HPV)

Human papillomavirus (HPV) vaccine (brand names Gardasil, Cervarix) is given in three doses over a six-month period, and is approved for girls between ages nine and 26. While there are over a hundred types of HPV, this vaccine protects against two sexually transmitted types that are the most common causes of cervical cancer. Gardasil also protects against two types that cause genital warts and is approved for boys between nine and 26 as well. The vaccine works only if given before an infection, so doctors recommend it for kids well before they could become sexually active. Although most states don't require HPV vaccination, many are considering mandating it for preteen girls.

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This article originally appeared on HuffPost.