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Nicole Karlis

"Time will tell" on FL measles outbreak

Cases of measles are spreading in South Florida. 

On Monday, officials in Broward County confirmed an eighth case of the virus nearly a week after news broke about a concerning rise in measles at a Broward County elementary school. The outbreak has quickly become politicized as Florida Surgeon General Joseph Ladapo and conservative officials have openly disregarded public health norms. While the Centers for Disease Control and Prevention (CDC) recommends that unvaccinated students stay home from school for three weeks after exposure, Ladapo said that the state's Department of Health "is deferring to parents or guardians to make decisions about school attendance.”

According to CBS News, around 200 students at one elementary school didn't attend class last Tuesday, and 174 missed class Wednesday — a sign that parents decided to keep kids home. Still, infectious disease experts tell Salon the rise of measles in Florida is something that should be of concern to all Americans, especially as spring break nears and people travel to the state for vacation, and that Ladapo’s response is disappointing and frustrating. 

“Whenever politics gets into public health, it can become a problem,” Dr. Sean O’Leary, who is the chair of the committee on infectious diseases at the American Academy of Pediatrics. “And in this case, it may end up harming children, which will just be a real tragedy if that's how this plays out.”

O’Leary said while it's important to keep children in school, that must be when it’s safe. “Many children who get measles will be hospitalized,” he said. “That's not a safe environment. I think it's terribly frustrating.”

Measles deaths occurred by the thousands in the first two decades of the 20th century. But by 2000, measles was declared eliminated from the United States, and no deaths were reported until 2015 when a woman in Washington was the first to die in 12 years due to complications from measles.

Since then, there has been an overall significant resurgence in the incidence rate of measles across the United States. Last year, more than a dozen unvaccinated children in Ohio were infected with the measles, with nine of them hospitalized. The Centers for Disease Control and Prevention (CDC) responded and deployed a small team to help assist with the outbreak. But by December, the number of infected children grew to 59. Most recently, as of January 6, the number of measles cases has increased to 82 cases; 33 of those were hospitalized.

Measles cases rise rapidly because the virus is so contagious. It can be easily spread by coughing, talking or being in the same room. It is estimated to infect 90 percent of unvaccinated people who are exposed.

“Measles is one of the most infectious diseases known to humankind,” Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis, told Salon. “And because of that, it requires a really good vaccine and a really high vaccination rate in order to control measles transmission.” 

The measles and rubella vaccine is extremely effective. After two doses, nearly 99 percent of people will be shielded against infection. While the vaccine was first developed in 1963, it wasn’t until 1980 when all 50 states had laws that required measles immunization for school enrollment. But since then, the so-called “Wakefield effect” has unrolled this progress. This effect refers to a thoroughly discredited British doctor, who claimed to document changes in behavior in children given the MMR vaccine, suggesting it could cause autism. This has seemingly contributed to the decline in vaccination rates.

Blumberg said once a community has a small cluster of cases, it’s like “small leak in a dike.”

“If you don't really address it, you know if that crack can widen and then it can just lead to a flood of cases,” he said. “That’s why mainstream public health doctors and scientists take that very seriously and do recommend isolation and quarantine measures.”

In order to control the spread of measles, a community needs a vaccination rate of around 95 percent. If it drops below that — even by a single percentage point — it can lead to localized outbreaks. Blumberg emphasized that measles isn’t just a fever and a rash. An estimated one in four cases will be hospitalized. In severe cases, there can be complications like pneumonia and encephalitis, which is when the brain swells. Before the measles vaccine was widely available in the U.S., nearly 400 to 500 children would die from measles and its complications each year. 

“Measles was a very, very nasty infection,” Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center, told Salon. “In addition to these illness components, it had major social consequences — number one, parents had to stay home to take care of the children, and that disrupted many parents' incomes.”

Schaffner emphasized it’s important to vaccinate children against measles, especially during a time when it’s being spread, because it helps protect the child and other unvaccinated children, usually children with immune system deficiencies.

As spring break nears, and many head to south Florida to vacation, is there a risk? O’Leary said if you and your children are vaccinated, there isn’t a risk. 

“Immunocompromised children are an important exception because certain immunocompromised children can't receive the MMR vaccine because it's a live vaccine,” he said. “And so for those families, yes, I think staying away from anywhere where there's a measles transmission is a good idea.”

He noted that when an outbreak is first identified “that's just the tip of the iceberg.”

“The incubation period for measles is relatively long,” he said. “It may have gotten beyond that small community, and we don't really know that yet for sure, but I think I think time will tell.”

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