Minnesota's Measles Outbreak Underscores US Vaccine Uptake Issue: Public Health Watch Report

The measles outbreak in Minnesota may officially be over, but the pesky issue of noncompliance with pediatric vaccination recommendations continues to, well, plague some communities across the country—with potentially troubling consequences.

As Contagion^® reported last week, a measles outbreak in the “Land of 10,000 Lakes” that affected 79 individuals, the vast majority of whom (73) were under 10 years of age, has been declared over by public health officials there, although not before those same officials made it clear what caused the problem in the first place: poor uptake of the measles, mumps, rubella (MMR) vaccine, particularly among children in the state’s large Somali-American population. Indeed, when the outbreak was first identified in April 2017, it was noted that more than half of the cases involved children from that very community. Overall, according to officials in Minnesota, only 42% of Somali-American 2-year-olds in the state receive the MMR vaccine (as recently as 2004, vaccination rates within the community were as high as 92%).

Interestingly, the reluctance of some Somali-American parents to have their children vaccinated against measles has been attributed to a campaign by anti-vaccine activists. These activists, some say, have taken steps to convince Somali-American parents that there are links between MMR prophylaxis and the onset of autism in young children, despite overwhelming scientific evidence to the contrary. The anti-vaccine movement has gained new traction in 2017, thanks at least partially to reports that Robert F. Kennedy, one of its leading activists, could chair a special committee on “vaccine safety and scientific integrity.”

However, neither the appointment, nor the committee itself, has ever come to pass, perhaps due to widespread opposition.

Still, the Minnesota outbreak is viewed by many in the public health community as a proverbial canary in a coal mine, and steps have been taken to taken to address the issue within at-risk communities. In Minnesota, for example, according to a report in The Washington Post, health officials have engaged religious leaders in the Somali-American community there in efforts to educate parents on the importance of the MMR vaccine in overall child health. Since the onset of the outbreak in April, figures suggest that vaccine uptake has more than tripled over where it was during the spring and summer of 2016.

And in California, where Senate Bill 277 (SB277) was passed in 2015 to eliminate the so-called “personal-belief exemption” from the state’s school-entry vaccination requirements for the 2016-2017 school year (and beyond), vaccination rates among incoming kindergartners have climbed to 97.3%, from a low of 92.6% in the fall of 2014. According to an analysis published on September 5, 2017 in the Journal of the American Medical Association (JAMA), although the number of medical exemptions from vaccination (which are still allowed under the law) filed with schools in the Golden State tripled from 2015, when SB277 was passed, to 2016, the overall number of vaccination exemptions filed by parents on behalf of their children dropped by roughly 230% over the same period. As a compromise, SB277 does grant physicians greater leeway in providing parents with medical exemptions from vaccination for their children; however, based on the JAMA analysis, parents and physicians don’t seem to be abusing this aspect of the provision—at least not yet.

Does this mean that the public debate over the issue of pediatric vaccination is drawing to a close? Unfortunately, far from it. Overall, MMR vaccination rates in the United States have held steady at around 92% for several years now, and until we achieve post-SB277 levels nationally, the only real question is when—not if—we will have another outbreak of measles and/or mumps.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.