Thursday Reads: Is the California Measles Outbreak a Product of Neo-Liberal Thinking?

Woman Reading on a Settee, William Churchill

Good Morning!!

I’m going to focus on just one story today. I wanted to try to understand something I’m curious about–what’s causing the rapid spread of measles in California?

The outbreak of measles that started at Disneyland in December is spreading rapidly across California, into other states, and even into Mexico. Five Disneyland employees have now been diagnosed with the disease (three have recovered and others are being tested), and the number of reported cases traced to Disneyland has passed 60.

Last week I wrote about an unvaccinated woman who contracted the measles virus in Disneyland and then took two airline flights to the Seattle area during the holidays before she was diagnosed. How many other people did she infect? Measles is highly infectious, airborne virus that can be spread by coughing and sneezing, like the common cold. From the CDC website:

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.

Infected people can spread measles to others from four days before to four days after the rash appears.

Another case was recently identified in Eugene, Oregon. The man is so sick that he hasn’t been able to talk to anyone, but his wife says he was in Disneyland and also went to the Rose Bowl game and then flew back home before he started showing symptoms. How many other people did he infect? UPDATE: It turns out the man did not go to the game–see story in comment thread.

Measles cases are also turning up in Northern California, according to SFGate: Disneyland measles outbreak spreads to Bay Area.

A large outbreak of measles that started at two adjacent Disney theme parks in December has now sickened people all over California, including a handful of Bay Area residents, and is prompting public health authorities to urge everyone to get vaccinated if they aren’t already.

California has reported 59 cases of measles since mid-December, the bulk of them in people who either visited or had close contact with someone who had been to Disneyland or California Adventure Park in Anaheim, public health officials said in a media conference call Wednesday. Seven measles cases have been reported in the Bay Area: in Alameda, San Mateo and Santa Clara counties.

Most of the people who have become infected were unvaccinated. Because of the threat of infection, public health officials said people who aren’t vaccinated — either because they can’t get the vaccine or they choose not to — should avoid public places where large groups of people, especially international travelers who may carry measles, congregate.

“We can expect to see many more cases of this vaccine-preventable disease unless people take precautionary measures,” said Dr. Gil Chavez, deputy director of the Center for Infectious Diseases with the California Department of Public Health. “I am asking unvaccinated Californians to consider getting immunized to protect themselves and family and community at large.”

I had measles as a child, and fortunately I didn’t develop any of the complications, such as blindness, severe ear infections, pneumonia, and encephalitis (rare). But now that we have a vaccine for measles, children don’t need to risk these possible dangerous consequences of getting the virus. Sadly, we have a lot of people in this country who believe conspiracy theories about vaccines.

How do the anti-vaxxers avoid the vaccines? Most states require vaccinations for children attending school, but most states also allow religious exemptions. Here’s a list of vaccine requirements in each state. Every state but Mississippi and West Virginia allows religious exemptions; a few states also allow “philosophical” exemptions. Only California allows “objections based on simply the parent(s) beliefs.” I’m guessing some parents avoid vaccinating their children by home-schooling them.

Bloomberg reports that Orange County has banned unvaccinated kids from attending school because of the measles outbreak.

Health officials in Orange County, Calif. have banned two dozen students who have no immunization records from attending high school in the wake of a measles outbreak that has been traced back to Disneyland.

Sixty-seven confirmed measles cases have been reported in California in the current outbreak. One student from Huntington Beach High School who was infected with the disease attended class following winter break, exposing fellow students to the highly contagious illness, especially those who did not receive a childhood vaccination against it.

“If there is a case in the school and their child is not immunized, they will be removed from the school for 21 days,” Dr. Eric Handler, the Orange County public health officer, told the Los Angeles Times. “From an epidemiological standpoint, in order to prevent spread of the disease, this is a necessary measure.”

Now check this out:

In Southern California…many schools now report that upwards of 10 percent of students have not received childhood vaccinations. In Northern California, the figures are even worse, with clusters of under-vaccinated children in the San Francisco Bay Area resulting in one out of every four children going without the recommended immunizations.

Herd Immunity

Most of the parents who opt out of having their kids vaccinated are relatively affluent and well-educated, according to science writer Tara Haelle at Forbes. She notes two reasons why measles is spreading so rapidly in California.

Those two things are the extreme infectiousness of the disease and the low levels of herd immunity, or community immunity, in pockets of southern California. Measles infects 9 out of every 10 non-immune individuals it finds. It’s airborne and hangs around up to two hours after an infected person leaves the area. It doesn’t take much for this disease to spread through a population that isn’t immune from previous exposure or through vaccination. Or, to put it another way, in an unvaccinated population, each person infected with the measles will transmit the disease to 12 to 18 other people. If no one were vaccinated against measles, we would be up to hundreds, perhaps thousands, of cases by now. We aren’t because there are some levels of herd immunity, but it’s because herd immunity has been weakened that we’re seeing additional cases at all.

She also debunks the notion that undocumented immigrants are spreading the virus.

Meanwhile, one of the biggest myths popping up in comment threads and on social media is that undocumented immigrants have something to do with this outbreak, or any other outbreak of a vaccine-preventable disease. We don’t yet know who Patient 0 – the first person with the disease – was at Disneyland, but we don’t really need to know. It’s not undocumented immigrants we should be pointing the finger at. It’s home-grown, upper-middle class, well-educated, mostly white southern California parents who have chosen not to vaccinate their children we should be giving the side-eye to. When vaccination rates in the region are below some developing countries’ rates, you don’t need undocumented immigrants to bring in the disease. Unvaccinated Americans do a fine job of that all on their own. A look at past cases makes this clear.

When the CDC tracked measles cases for the first half of 2013, they found that 159 cases resulted from 42 importations of the disease – but more than half those importations were U.S. residents returning to the States from abroad. Similarly, the outbreak of close to 400 cases in Ohio last year began with unvaccinated U.S. travelers returning from a visit to the Philippines. And the largest outbreak in San Diego since 1991 occurred in 2008 after an intentionally unvaccinated 7-year-old boy returned from a vacation in Switzerland with his family and brought back the measles. That last case is particularly of interest because the boy was a patient of Dr. Bob Sears, who has been spreading misleading information about measles in the midst of this outbreak.

Interestingly, she says that some people who have been vaccinated will still get the disease. But someone who hasn’t been vaccinated is 35 times more likely to get measles than someone who has had the vaccine.

Dr. Bob Sears

Here’s some more information about Dr. Bob Sears, and Orange County pediatrician and author of “The Vaccine Book: Making the Right Decision for Your Child.” From the LA Times: Vaccination controversy swirls around O.C.’s ‘Dr. Bob.’

While the vast majority of physicians are troubled by the anti-vaccination movement, Sears, 45, lends a sympathetic ear. About half his patients forgo vaccines altogether. To others, he offers “Dr. Bob’s” alternative and selective vaccination schedules, which delay or eliminate certain immunizations.

At a conference this year in Rancho Mirage, Sears told a roomful of pregnant women, new mothers and healthcare professionals that vaccines work well and are responsible for the nation’s low disease rate, something parents who don’t want to immunize can take advantage of.

“I do think the disease danger is low enough where I think you can safely raise an unvaccinated child in today’s society,” he said. “It may not be good for the public health. But … for your individual child, I think it is a safe enough choice.”

That approach frustrates infectious-disease experts, who in recent years have found themselves combating some celebrities’ anti-vaccination beliefs.

“We eliminated endemic measles in the U.S. in 2000. It’s now 2014 and we’re at 400 cases. Why?” Dr. Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia, said in an interview in June. The number of cases has since risen to nearly 600. “Because people listen to Bob Sears. And, frankly, I blame him far more than I do the Jenny McCarthys of this world. Because he’s a doctor. And he should know more.”

Here’s an interesting article from The New Republic, The Best Way to Combat Anti-Vaxxers Is to Understand Them A new study underlines the similarity between “neo-liberal” thinking and the anti-vaccination movement. Well The New Republic should certainly understand neo-liberal thinking–they practically invented it. An excerpt:

“Anti-vaxxers,” as they are often referred, are an easy group to stereotype and a difficult group to humor. In most thinking circles, they are cast as “the other”; people either too stupid to understand the science behind vaccination, or too selfish to care about the impact of their choices on those around them.

But vaccine skeptics aren’t as different from their critics as we might like to think. And their rise in number over the past decade has less to do with stupidity, or even selfishness, than it does with beliefs about knowledge, trust, and freedom of choice that are pervasive throughout our culture, whether you choose to vaccinate your kids or not.

Dr. Jennifer Reich, a sociologist at the University of Colorado Denver, has been researching the anti-vaccination movement since 2007, seeking to understand the processes by which people come to reject vaccines. Over the past seven years, she has conducted in-depth interviews with parents who refuse mainstream vaccine recommendations, along with doctors, alternative healers, and public policymakers.

Not all of the parents Reich spoke with were “anti-vaxxers” in the sense that we typically think of the term; only a small minority identified as activists in the Jenny McCarthy mold, campaigning other parents not to vaccinate or advocating for policy change. Nor did they necessarily abstain from vaccination completely.

Rather, what united them was a sense that vaccines were up for negotiation: to be administered or rejected depending on the convictions of the parent and the needs of the child. Reich’s interviewees saw themselves as critical consumers of information. They engaged with doctors not as authorities to be obeyed, but as another data point to be evaluated, embraced, or discarded. They continually assessed risk: How likely was it that their child would be exposed to Disease A? What would be the consequences if they contracted Disease B?

It seems to me that what these anti-vaxxers have in common with neo-liberals is that they have lost the sense that as Americans we are all in this together. They focus only on their own needs and ignore the ways in which their choices about whether to vaccinate their children could impact others and society as a whole.

Just one more article before I wrap this up.

From Philly.com: California Measles Outbreak Shows How Quickly Disease Can Resurface in U.S.

Fifteen years after measles was declared eliminated in the United States, the recent outbreak traced to two Disney parks in California illustrates how quickly a resurgence can occur….

Experts explain the California outbreak simply.

“This outbreak is occurring because a critical number of people are choosing not to vaccinate their children,” said Dr. Paul Offit, director of the Vaccine Education Center and an attending physician at The Children’s Hospital of Philadelphia’s Division of Infectious Diseases.

“Parents are not scared of the disease” because they’ve never seen it, Offit said. “And, to a lesser extent, they have these unfounded concerns about vaccines. But the big reason is they don’t fear the disease.” ….

Researchers have found that past outbreaks of vaccine-preventable diseases are more likely in places where there are clusters of parents who refuse to have their children vaccinated, said Saad Omer, an associate professor of global health, epidemiology and pediatrics at Emory University School of Public Health and Emory Vaccine Center, in Atlanta.

“California is one of the states with some of the highest rates in the country in terms of exemptions, and also there’s a substantial clustering of refusals there,” Omer said….Other reasons include the belief that their children will not catch the disease, the disease is not very severe and the vaccine is not effective, Omer noted.

In California, vaccine exemptions have increased from 1.5 percent in 2007 to 3.1 percent in 2013, according to an analysis by the Los Angeles Times.

So, in a sense California is endangering people in other states. Omer says there’s recent legislation to make it more difficult to get exemptions, but “it is too soon to know the effects of the new law.”

So . . . comment on this issue if you wish; but feel free to treat this as an open thread. Have a great day Sky Dancers.