Health officials express concerns over recent outbreaks of measles and chickenpox.
There are cases popping up all over, and there’s a simple reason behind it.
At a private school in North Carolina, 36 children developed chickenpox in a community that has the highest rate of vaccination exemptions for religious beliefs.
In New Jersey, one county has 18 people infected with measles in an outbreak state health officials continue to monitor.
In Rockland County in New York, 87 people have received diagnoses with measles in an on-going outbreak after local residents visited Israel, where an outbreak has infected nearly 900 people.
New York state health officials warn people that measles is one of the most contagious viruses on Earth and, as a result, 90 percent of unvaccinated people exposed to the virus contract it.
The World Health Organization (WHO) recently warned that reported cases of measles spiked in 2017 because multiple countries — due to gaps in vaccination coverage — experienced severe outbreaks of the preventable disease.
WHO estimates 110,000 died from measles last year.
Overall, reported cases have increased by more that 30 percent across the globe since 2016.
The worst appears to be happening in the Americas, the eastern Mediterranean region, and Europe, according to a new report by leading health organizations.
In some countries, such as Afghanistan — which leads the globe in measles infection rates — access to potentially life-saving medicine is in short supply and hard to come by.
In other countries, many people opt out of vaccinations for a variety of personal and religious reasons.
Dr. Soumya Swaminathan, deputy director-general for programs at WHO, says the resurgence of measles “is of serious concern,” and the most troubling areas are those that were close to eliminating measles.
“Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating but entirely preventable disease,” she said in a statement.
Opting out of vaccinations
Diseases such as measles and chickenpox are seeing a resurgence because of an increasing number of parents who opt out of vaccinating their children, officials say.
According to the Centers for Disease Control and Prevention (CDC), the percentage of 2-year-olds who have never received a single vaccination has quadrupled since 2001, reaching 1.3 percent of children born in 2015. While that’s still a relatively low number, it does reflect a change.
There appears to be distrust in vaccinations in a generation who may not have any firsthand knowledge of the diseases routine shots prevent. This includes the once-common chickenpox and measles.
Herd immunity — when large swaths of the population are immunized — is one of the best defenses humanity has against diseases like measles, which are easily spread through sneezing and coughing.
For protection against measles, about 93 percent of a community needs to get vaccinated, according to Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine in New York.
For other diseases, it can be as low as 80 percent.
“Remember, no vaccine is 100 percent effective, so protection depends on the uptake of vaccine in the community, plus how effective the vaccine is, plus how infectious the illness is,” Nachman told Healthline. “It’s really a complicated equation.”
Out of sight, out of mind
Because some diseases, such as measles, have been removed from society for so long, many people don’t have firsthand knowledge of what it’s like having the disease: the high fever, itchy and painful rash, and even bronchitis, pneumonia, and encephalitis, or swelling of the brain.
Measles was actually considered eradicated, or not continually being transmitted year-round, in the United States in 2000, says the CDC.
Because measles doesn’t have a home in the United States, some parents question the importance of vaccines and choose not to have their children vaccinated.
But the United States, and the rest of the world, isn’t an isolated island. Some people don’t take into account the mobility of the pathogen within the population, Nachman says, especially when people are getting on planes and ships to and from foreign countries.
“Not only are they seeing vaccine-preventable illnesses and multidrug-resistant bacteria, they are bringing these back with them in their travels,” she said.
Such was the case of an outbreak in Disneyland in 2015, when at least 26 people at the park contracted measles after a visitor brought the virus from a foreign country. Many of those who got measles weren’t vaccinated.
The exact opposite happened the previous year in the San Francisco Bay Area. A person carrying the virus rode mass transit for several days in 2014, but there were no reported secondary infections because of the area’s high vaccination rate.
Dr. Dana Hawkinson, with the infectious disease department of the University of Kansas Health System, says the safety and efficacy of these vaccines has been repeatedly shown through rigorous scientific study.
Should parents have questions, they should consult their healthcare provider, he says.
“The overall risk to benefit ratio of the vaccines is of very low risk compared to great potential benefit,” Hawkinson told Healthline. “Vaccines have prevented complications, which can occur with some of these vaccine-preventable diseases, such as encephalitis with diseases such as measles or chickenpox.”
But herd immunity also protects those who aren’t healthy enough to be vaccinated and could fare far worse should they come in contact with the virus.
Melody Butler, a registered nurse and founding executive director of Nurses Who Vaccinate, says this group includes children who are under 1 year old and children who are severely ill, including those with a weakened immune system due to cancer treatments or other medical issues.
Butler had hoped that measles would soon have been eradicated globally. But due to the recent outbreaks and increase in cases, she says it won’t be as easy as it should be.
“Like smallpox, measles is only found in humans, and our vaccine is incredibly effective in providing protection,” she told Healthline. “However, when dangerous misinformation continues to scare parents and patients from vaccinating, it’s a tougher battle to protect our communities from vaccine-preventable diseases.”
‘Leave it to chance’
Dr. Christopher Harrison, director of both the infectious disease research laboratory and vaccine and treatment evaluation unit at Children’s Mercy-Kansas City, says that anti-vaccine groups promote fear of vaccines through various media, enlisting the help of celebrities and politicians.
This, he says, can put families in a conflicted position.
Parents who want to do what’s best for their children may be reluctant because they’ve heard “the non-science-based ‘information’ or opinions, and have difficulty differentiating ‘junk data’ from real scientifically based data,” he said.
“They have usually not seen the suffering and complications from vaccine-preventable diseases,” Harrison told Healthline. “They usually do know or have heard of someone who claims that vaccines were the cause of some problem that is a better known or more prevalent condition for which a defined cause is not well described, i.e. autism.”
Children who have autism aren’t an abstract concept, Harrison says, while vaccine-preventable diseases usually are abstract and distant. So, some families may decide to avoid vaccines to reduce their immediate and longer-term worries.
“They feel that if a vaccine-preventable disease occurs, that will be bad luck and Mother Nature’s fault,” he said. “So, better to leave it to chance than make a decision for which there seems to be conflicting opinions.”
Dr. Randy Bergen, a pediatrician with The Permanente Medical Group in Northern California, says there’s “no question that vaccines are a victim of their own success.”
In his practice, he says he can never prove that the reason a child hasn’t gotten sick from a disease is because they were vaccinated for it.
He says this is why doctors and scientists use infection rates and statistics to explain the benefits.
“But if we look at how the incidence of measles has been reduced from a million cases a year to thousands of cases a year, that means millions of children will never have to know what measles is like,” Bergen said. “The other thing that I wish parents who are risk adverse would take into consideration is that their decision not to vaccinate their children would be considerably riskier if many other parents made the same decision.”
It goes back to herd immunity.
Children who aren’t vaccinated are still protected by those who did vaccinate their children.
To Bergen, there’s a clear societal benefit — and therefore an obligation — to consider the health of all children within the community.
“I think that sometimes parents who make the decision not to vaccinate their children do not consider the health of other children as much as they should,” he said.
The bottom line
Health officials say recent outbreaks of measles and chickenpox in North Carolina, New York, and New Jersey are due, at least in part, to parents who decide not to vaccinate their children.
Officials say there’s been an increase since 2001 in the number of young children who have never received a vaccination.
They say many of these parents grew up in a world where once-common chickenpox and measles are rare.
This lack of firsthand knowledge as well as unscientific information about vaccination side effects may be fueling this trend, they say.