Public Health

Will measles outbreaks finally lead to fewer exemptions?

With 41 new cases reported the previous week, there are now 880 confirmed cases of measles in 24 states this year as of May 17, according to the Centers for Disease Control and Prevention.

That’s the highest number since 1994, which occurred six years before the 2000 declaration that the disease had been eliminated in the U.S. But these alarming figures appear not to have created a sense of urgency in state legislatures, with the notable exceptions of Maine and Washington.

Maine Gov. Janet Mills is expected to sign one of the most comprehensive vaccination-exemption bills in the nation. The measure passed the state Senate by an 18–17 vote May 14, and is expected to clear procedural votes needed before going to the governor.

When the bill is signed, Maine will join California, Mississippi and West Virginia as the only states that do not allow parents to seek philosophical or religious exemptions from school-entry immunization requirements.

(Editor’s note: Mills signed the bill on May 24. It will remove all nonmedical vaccination exemptions for students in private and public schools­, including universities and nursery school, by 2021.)

While measles has been fueling much of the vaccine discussion, in Maine the issue is with pertussis. The Portland Press Herald reported that Maine had the highest rates whooping cough rates in the nation for 2017, the last year state-by-state comparisons were available. And the number of cases rose to 446 in 2018 from 410 in 2017.

“When someone chooses not to vaccinate, that decision can jeopardize the health and safety of entire communities, especially the weakest and most vulnerable among us,” Nancy Beardsley, acting director of the Maine Center for Disease Control and Prevention, said at a March 13 legislative hearing. “Those who are unable to be vaccinated, such as young infants, pregnant mothers or children with cancer, face the most risk from disease complications.”

In Washington, Gov. Jay Inslee signed a bill eliminating the personal and philosophical exemptions to requirements that children attending a school or daycare center receive the measles, mumps and rubella (MMR) vaccine. The legislation still allows exemptions on religious grounds.

The issue of religious exemptions has stalled a vaccination bill in Oregon, where it was approved in the state House but has stalled in the Senate.

Where the AMA stands

AMA policy supports prevention of childhood disease through immunizations. To this end, the AMA sent letters to legislative leaders in Maine, Oregon and Washington supporting legislation removing nonmedical exemptions in those states.

“Vaccines not only protect the child who receives them, but just as importantly, they protect the health of the community in which the child lives,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a May 1 letter to Oregon legislative leaders. “When vaccination levels are high, children who cannot be protected directly by the vaccines are partially protected because they are not exposed to the disease.”

A letter was also sent to the chair of the Arizona House Health and Human Services Committee opposing bills that would discourage immunizations—including one that would require the state’s health department to “disseminate extensive information to parents that overemphasizes the risks of immunizations.”

The AMA encourages physicians and other health professionals to make a strong recommendation for vaccination, reinforce that vaccines are safe and effective, and be prepared to answer patient questions when asked. Doctors and other health professionals also should explain the health risks associated with forgoing vaccination. Patients should discuss concerns they may have about immunizations with their doctors.

“The reductions we have seen in vaccination coverage threaten to erase many years of progress as nearly eliminated and preventable diseases return, resulting in illness, disability and death,” said AMA President Barbara L. McAneny, MD.

The CDC has also recently issued a “dear provider” letter that outlines its recommendations for measles vaccinations for adults.

How New York officials are responding

The measles outbreak has been particularly severe in the Brooklyn and Queens boroughs of New York City and in neighboring Rockland County, New York. About 500 measles cases have been confirmed in Brooklyn and Queens since September, and city health officials issued an order for “every adult and child who lives, works, or resides” in four ZIP codes to receive the MMR vaccine if they are not already vaccinated.

Adults and the guardians of children who violate the order face a $1,000 fine. The order is waived if it can be proven they are immune or have a medical condition that prevents them from being vaccinated.