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United Against Measles

The Bloomberg School convened experts Monday, February 9 to discuss the science and policy of a preventable outbreak.

Speaker at 2015 Measles Symposium.

Revising vaccine exemption policies, understanding the motivations of vaccine-hesitant parents and working more closely with physicians are among the recommendations from experts at a February 9 measles symposium at the Johns Hopkins Bloomberg School of Public Health.

Despite an effective measles vaccine, cases imported from overseas and pockets of low vaccination coverage will continue to test U.S. public health agencies. From the protein structure of the virus, to development of the measles vaccine and the concerns of anti-vaccine parents, speakers covered key issues to explain the current outbreak and explore what can be done to prevent a widespread measles resurgence. The symposium was moderated by Richard Besser, MD, ABC News’ chief health and medical editor.

The California outbreak that originated in late December at Disneyland is a “teachable moment,” according to retired U.S. Rep. Henry A. Waxman, an influential public health lawmaker. “When we see a disease that was almost completely eliminated in the early 1980s, now come back with a jolt all around this country, we have to ask ourselves what is going on, why are we experiencing this serious problem?”

Between December 28, 2014, and February 6, 2015, 114 people from seven states, plus four in Canada and one in Mexico, have been infected with measles linked to the Disneyland outbreak, said Jane Seward, MBBS, MPH, deputy director, Division of Viral Diseases, of the CDC’s National Center for Immunization and Respiratory Diseases. The majority of cases were not vaccinated or did not know their vaccination status.

Despite the effectiveness of the measles vaccine, Seward pointed out that there are an estimated 20 million measles cases and 146,000 deaths worldwide each year.

“When measles happens anywhere in the world, it can come here on a plane and spread very quickly,” Seward said.

For Neal Halsey, MD, director of the Institute for Vaccine Safety at the Bloomberg School, who watched children die from measles early in his career, the outbreaks that have followed the CDC’s 2000 announcement of measles elimination in the U.S. are particularly painful because the measles vaccine has been proven safe and effective.

“Here’s one single vaccine that prevents more than a million deaths every year,” said Halsey.

Despite the achievements of the measles vaccine and others, public health officials are noting a worrisome trend. The rates of vaccine hesitancy and refusal are increasing, said Daniel Salmon, PhD, MPH, deputy director of the Bloomberg School’s Institute for Vaccine Safety.

Research indicates that scare tactics will likely not yield successful results, noted Salmon. However, studies show that almost half of resistant parents agree to vaccinate if the physician continues the discussion after the initial refusal.

Other promising options include educating pregnant women about child vaccines and tightening nonmedical vaccine exemption laws.

Interactions at doctors’ offices also need to be considered, said health communications expert Debra Roter, DrPH, MPH. While conversations between doctors and vaccine-hesitant parents are often difficult and time-consuming, she emphasized that collaboration and respect must define the parent/pediatrician relationship.

“More than anything else,” said Roter, “parents want to be sure that what they do is the right thing for their child.” 

At the conclusion of the symposium, Baltimore City Health Commissioner Leana S. Wen, MD, MsC, and white-coated pediatricians from 10 hospitals throughout the region announced a consensus statement  urging parents across the nation to join Baltimore in keeping measles and other preventable illnesses from rising again: “We have had zero cases of measles in Baltimore. Zero deaths. [But] we cannot become complacent.”

View a webcast of the half-day symposium—“Measles Rises Again: The Science and Policy of a Preventable Outbreak.” —Jackie Powder and Maryalice Yakutchik