Texas Surge In Anti-Vaxxers Could Be Driving Its Latest Measles Outbreak

Anna Almendrala
Updated

A small measles outbreak in Ellis County, Texas, has infected six people ranging in age from 8 months to 27 years. None of them had been vaccinated for the disease. Skipping vaccinations is a growing trend in the state, and public health experts have been warning about outbreaks like this for years.

The Texas Department of State Health Services tweeted the news about the initial patient last Friday, and then by Tuesday there were five more cases. Because the first patient went to a movie theater, officials warned residents to watch for symptoms if they had been to that theater the same day.

The subsequent five cases were not linked to exposure at the cinema, officials said.

Texas is extremely vulnerable to measles outbreaks for several reasons. It is one of 19 states that allow parents to opt out of public school vaccination requirements on the grounds of their “conscientious” beliefs — as opposed to medical need. The rate of Texas parents requesting “conscientious exemptions” to vaccinating their children has risen steadily since the law was changed to allow that in 2003.

Texas could be called a battleground state for the anti-vax movement. It is home to Texans for Vaccine Choice, a PAC that promotes politicians who support its donors’ distrust of vaccines. And it’s the home of Andrew Wakefield, the disgraced U.K. doctor who was stripped of his medical license after he was found to have falsified data in a much-hyped study that purported to show a causal link between the measles-mumps-rubella shot and autism. His paper has since been retracted.

Conditions like these have Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, convinced that Texas will likely see even larger measles outbreaks. In October 2016, Hotez published a column in PLOS Medicine predicting that the state’s declining vaccination rates would result in an outbreak in either the winter or spring of 2018 that might eclipse the 2013 Texas outbreak. That outbreak was linked to a megachurch where the founders expressed suspicion that childhood vaccines could cause autism — a baseless claim that has been refuted in several studies involving thousands of children.

“As both a vaccine scientist and autism parent who has written about why vaccines don’t cause autism, to me these drops in vaccine coverage represent a potential self-inflicted wound,” Hotez told HuffPost. “With this latest measles outbreak in North Texas, we now have the wound and it’s an ugly one. I hope it does not expand into a much larger outbreak.”

In the 2003-2004 school year, the first in which the conscientious exemption was available, the parents of 2,314 students filed for one. By the 2016-2017 school year, that number was 52,756 students. And those figures don’t include the number of home-schooled children who may not be vaccinated, Hotez said.

“Texas has seen a 20-fold increase in non-medical vaccine exemptions since 2003,” the doctor said. And the result is that “we have some schools with 20 to 40 percent of the children not being vaccinated.”

Measles is a very contagious virus with a very high “basic reproduction number” of 12 to 18. That means every person who gets measles can expect to transmit the virus to 12 to 18 unvaccinated people. In contrast, the reproduction number of the Ebola virus during the most recent outbreak was between 1.5 and 2.5. Because measles is so contagious, communities need to be vaccinated at a rate of 90 to 95 percent for herd immunity to stop the disease from spreading.

It can take as long as three weeks before someone exposed to the virus begins to show symptoms, which include the tell-tale rash, high fever, cough, runny nose and red, watery eyes. Generally, infants don’t receive their first measles vaccine until at least 12 months, with a second shot completing the series at around 4 to 6 years old.

Publicly available data about the rate of personal-belief exemption requests in Texas show that some schools are already well below the measles vaccination rate needed to achieve herd immunity. In the latest outbreak, officials say the virus has not been found to be infecting people at schools or day care centers ― but that’s this time.

Take the six current cases, which officials say have connections to the towns of Waxahachie and Midlothian. The school districts in both towns have a personal-belief exemption rate of 1.24 percent — about 28 percent higher than the state average. Two private schools in Waxahachie report even higher rates: Life School has a rate of 1.76 percent, while Waxahachie Preparatory Academy reported a whopping 22.89 percent. Ellis County overall has an exemption rate of 1.21 percent.

Three counties surrounding Ellis also have higher-than-average rates of personal belief exemptions. Tarrant County, which has a countywide exemption rate of 1.27 percent, has 15 private schools with exemption rates ranging from 5.2 percent to 41 percent. Johnson County, which has an overall exemption rate of 1.55 percent, has five schools with rates ranging from 5.4 to 32.5 percent. Henderson County, with an overall exemption rate of 1.1 percent, has one school with an exemption rate of 7.58 percent.

Recent measles outbreaks in the U.S. offer some hope that public concern and government action can push vaccination rates back up again. As a response to the 2014 measles exposure in Disneyland that infected 111 people, California passed a tougher vaccination law the following year, banning both religious and personal belief exemptions for children entering school and daycare.

Vaccines expert Patsy Stinchfield hopes that other states will follow California’s example and do away with the personal belief exemption.

“‘Personal belief exemptions’ sounds like ‘I am making a decision for myself personally,’” said Stinchfield, a senior director of infection prevention and control at Children’s Hospital Minnesota. “But the virus doesn’t think that way or work that way.”

Last summer, Minnesota experienced a measles outbreak concentrated among Minneapolis’ Somali immigrants, who were afraid the shots might cause autism in their children. In total, 79 people got measles, most of them under 10 years old. Seventy-one of the patients had not been vaccinated for measles.

“The virus doesn’t care if you are a person with personal belief exemptions or a newborn baby or a pregnant unvaccinated woman or a grandma undergoing chemotherapy for breast cancer,” Stinchfield said. “All the measles virus knows is that person is not immune.”

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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.