In this Thursday, Jan. 29, 2015, photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The largest measles outbreak in recent memory occurred in Ohio's Amish country where 383 people were sickened last year after several traveled to the Philippines and brought the virus home. While that outbreak got the public's attention, it's nowhere near the level as the latest measles outbreak that originated at Disneyland in December, prompting politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (AP Photo/Damian Dovarganes)
In this Thursday, Jan. 29, 2015, photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The largest measles outbreak in recent memory occurred in Ohio's Amish country where 383 people were sickened last year after several traveled to the Philippines and brought the virus home. While that outbreak got the public's attention, it's nowhere near the level as the latest measles outbreak that originated at Disneyland in December, prompting politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (AP Photo/Damian Dovarganes) (Damian Dovarganes, AP)

Measles, a highly contagious, sometimes fatal viral illness was virtually eradicated from this country until fairly recently, when a U.S. outbreak has attracted a media spotlight on what health officials say is a dangerous trend of parents forgoing the measles vaccine for their children.

The Centers for Disease Control and Prevention's measles website indicates that 2014 saw a record number of measles cases for the 21st century at almost 650 — measles cases have exceeded 100 in only six years since 2001 — while a January outbreak traced to Disneyland in California has grown to 102 cases in 14 states since Jan. 1.

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"It's being exacerbated by pockets of low vaccination rates so that it spread more quickly," said Dr. Scott Krugman, the previous president of the Maryland chapter of the American Academy of Pediatrics. "It hit Disneyland in California, and they have some of the areas with very low vaccination rates."

Maryland and Carroll County in particular have been immune to the recent resurgence of the once-eradicated measles, according to Krugman. As a reportable disease, measles cases are submitted to the Maryland Department of Health and Mental Hygiene, and according to DHMH data, Carroll County saw one case of measles between 2005 and 2013, the most recent period for which numbers were available. There have only been nine cases of measles in the state over that same time.

DHMH data for the 2013-2014 school year show that 97.9 percent of new kindergartners that school year had been vaccinated against the measles, with most counties falling between 95 and 100 percent vaccinated. Carroll reported a 99.3 vaccination rate; Frederick reported 99.4; Howard was at 98.8; and Baltimore County reported 98.9.

Wicomico County reported the lowest rate in the state at 91.6, still a far cry from the 30 to 50 percent vaccinated rates Krugman said some areas of California show.

"Our community has been more receptive than communities around the country to vaccination, and pediatricians spend a lot of time talking to parents about vaccinations," Krugman said. "We just have to keep vigilant because it's very quick: If those vaccination rates go down just a little bit, we could have a major outbreak in our communities."

The key problem with measles, according to Krugman, is that it is exceptionally contagious, lingering in the air for more than an hour after an infected and contagious person has moved on.

"Everyone was freaking out about Ebola, but it's very hard to catch Ebola," he said. "Measles stays on surfaces, and it's airborne, truly airborne, so it's a double whammy."

Measles is an upper respiratory disease caused by a virus that presents itself as a distinctive rash on the skin, and, for most children, that's all it is, a week of being miserable, Krugman said. One in 1,000 children with measles, however, will develop viral pneumonia, which Krugman said is not treatable with antibiotics. One in 10,000 will develop measles encephalitis, an infection of the brain.

"They will get brain damage and they could die," Krugman said. "Before the [measles vaccine], there were about 500 deaths per year [in the U.S.]. It was not uncommon."

The World Health Organization estimates 145,700 people around the world died from measles in 2013, according to the WHO measles website. It also estimates that the measles vaccine has prevented more than 15 million deaths globally between 2000 and 2013.

The recommended schedule for the measles vaccination, which is given as one component in the measles-mumps-rubella, or MMR, vaccination, is one shot at 12 months old and a booster at 4 years old, according to Krugman, and it provides immunity into adulthood for most people.

"It's easy to do a blood test that will look for the amount of measles antibodies in your system," he said. "If there is an outbreak and you have any questions about your immunity, you can check to see. You can always get a third or fourth shot."

The MMR vaccine is also one of the required immunizations for students attending public schools in Maryland, according to Carroll County Public School's Supervisor of Health Services Filipa Gomes. When new students enroll, a school nurse checks their immunization records and then contacts parents of any child who remains unvaccinated.

There are exceptions to the immunization requirement, however. According to Gomes, parents can also supply one of two kinds of exemptions in lieu of an immunization record: medical or religious. Medical waivers require a physicians note explaining the reason for a permanent or temporary medical exemption, while a religious exemption requires parents fill out a form saying it is against the family's bona fide religious beliefs to vaccinate their children.

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According to DHMH data, the state granted about 221 medical exemptions in the 2013-2014 school, about 0.3 percent of the 73,745 kindergartners in public and private schools. About 516 students in the state were given religious exemptions, or about 0.7 percent of the kindergarten population.

Carroll County granted about 10 medical exemptions in the 2013-2014 school year, about 0.5 percent of 1,978 kindergartners in public and private schools. The religious exemption population was 0.9 percent, or about 18 students.

Schools report the vaccination rates and numbers of exemptions to DHMH annually, but there are limitations to this data, according to DHMH spokeswoman Karen Black. She said that in the 2013-2014 schools year, 92 percent of Maryland public schools and 68 percent of private schools in the state reported vaccination or exemption numbers. Even though the Code of Maryland Regulations requires that all public and private schools keep a count of all students with a religious exemption from vaccination requirements and that they furnish the secretary of DHMH with this number no later than Nov. 15 each year, Black said there is no enforcement mechanism to make schools comply.

DHMH has not yet analyzed the 2013-2014 school year data for Carroll County by school, according to Black, so it is not possible to know whether every private school in Carroll is included in the DHMH data. Carroll County Public Schools, however, have reported everything, according to Gomes.

"We send all our records. They can be completed online now; each school nurse can go ahead and fill it out," Gomes said. "As far as I know, every public school system does that. I am on the committee of school health supervisors meetings, and we meet regularly with the Maryland State Department of Education, and I have never heard in any of these meetings that a school system has decided not to do that."

Carroll County Public Schools also keeps more thorough and up-to-date numbers than what is reported to DHMH, according to Gomes, who provided numbers for the current 2014-2015 school year.

"We have 114 medical and 144 religious exemptions and that's this school year, 258 students," she said. "This is actually better data than what you will get from the state, since they only asked for newly enrolled students, and I am looking at all of our students."

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Gomes said that there does not appear to be any clear trend toward a greater number of religious exemptions in Carroll County Public Schools, certainly not on the scale of some California schools with their low vaccination rates.

"The numbers to me are low enough that I don't think there is [a trend]. Four students in a school building is not that many. One school may have 10, but that school population might be 1,000 students, and there might be [no exempt students] in other schools," Gomes said. "If we have an outbreak, [the school nurses] have to know which kids are not immunized so they can call those families and keep those kids home. In some schools, it's only a few kids."

Overall, Krugman said, the state of measles immunity in Maryland is good, and while he wouldn't be surprised to see one or two cases, the chance of an outbreak on the scale of the one that started in Disneyland is unlikely. At the same time, it would be a mistake to take that fact for granted.

"We're doing well and we need to keep doing well," he said. "But we know we have families out there that don't have the measles vaccination, and this is a wake-up call for those families to realize these diseases are real. They exist, and the disease is worse than any potential side effects of the vaccines, which are minor and not long lasting, which the measles can be."

Reach staff writer Jon Kelvey at 410-857-3317 or jon.kelvey@carrollcountytimes.com.

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