The preventable disease outbreak was "inevitable" with low vaccination rates


Alan Melnick is frustrated and open to new ideas. The Clark County health officer and his staff are in the fourth week of a public health crisis that Washington has not seen before and suspects that the measles outbreak that has already affected 23 people at that time will only grow in the foreseeable future

But what has him so frustrated that he is looking for information is that the rapid spread of the sometimes deadly disease is preventable. But for years, vaccination rates in Clark County have remained well below the threshold to prevent a highly contagious disease such as measles from wreaking havoc in a community.

"The bottom line is that it's no wonder we're seeing this now," Melnick said. "If we do not increase our vaccination rates, we will see more in the future."

The disinformation that has fueled the decline in vaccination rates, largely born of a discredited claim that vaccines cause autism, seems to be as contagious as measles itself. Clark County, like other health agencies and news organizations, is bombarded on social media with myths and "junk science" about the dangers of vaccination. Melnick sees that the links appear on Facebook and are disseminated because the articles seem to have a good origin and the websites look professional.

"That's rubbish, but it's out there, and they're making it look good," Melnick said in an interview on Wednesday.

By Friday, the number of confirmed cases of measles would increase to 30 from January 1. The list of places where people with measles might have spread to others includes nine health centers, nine schools, three churches, the Portland International Airport and a Portland Trail Blazers game.

Infected people bought at Costco and the high-end grocery store Chuck & # 39; s Produce. They went out to eat and met with their financial planners.

If the Vancouver area complies with what is called "herd immunity," the number of people who need to be vaccinated to stop a contagious disease would be good activities. But you need a 93 percent vaccination rate to achieve herd immunity, and in 2017, the Vancouver area had only 66. That means that people who have never received a vaccine, people who have weak immune systems, children too young to receive a vaccine or people who can not, for a medical reason, are in danger of the air when they leave the house.

Melnick has an immunoglobulin pool that can help prevent the disease, but she's rationing it for more serious cases, such as pregnant women, who are much more likely to miscarry or stillbirth if they are infected with measles.

Measles outbreaks usually go in 21-day cycles. The virus radiates from the original carriers to their personal community first, then to the wider community through the central locations, then to people who become infected second hand and then spread it to their own communities.

Melnick expects the disease to cross the state and county lines eventually. It is possible that there already … a man in King County with measles visited southwest Washington before he was diagnosed.

Before the measles vaccine became available, between 400 and 500 people died each year, according to the US Centers for Disease Control and Prevention. UU Each year, approximately 1,000 people face one of the most serious consequences: inflammation of the brain, which can cause life-long problems.

Almost all children under the age of 15 in the US UU They contracted measles before 1963. But after the vaccination became widespread, that number decreased so much that the 30 people diagnosed in Clark County are one of the biggest outbreaks nationwide.

At the same time, New York has more than 160 cases of measles in an outbreak that took hold in an Orthodox Jewish community, where many people are not vaccinated and spend most of their days working, socializing and worshiping together.

Melnick said the Vancouver outbreak is not limited to any religion or demographic population. But it still has the potential to be as big and dangerous as New York's.

"It's what keeps me awake at night," Melnick said. "This could be exponential. It's like taking gas and throwing a match. "


Clark County and state health officials say they still do not know how the outbreak began. In general, measles is returned by someone who traveled abroad and then, unknowingly, introduces it into the US. UU

The New York outbreak has been linked to a measles outbreak in Israel, where members of the New York Jewish community visited or received guests.

Health officials in Washington have not identified a source and say they are too busy at this time trying to mitigate the outbreak's scope to devote more resources to research.

And officials say they need more resources. On Friday, Governor Jay Inslee declared a state of emergency to access health care from other states and deploy all available agencies in the state of Washington to help with the response to the outbreak.

State data and national research show that there are trends in who is vaccinated and who is not. The demographics are varied and make it difficult to pinpoint who could be the culprit.

Resistance to vaccination often falls through political divisions. The Christian and Waldorf schools in Oregon report some of the lowest vaccination rates, although parents who send their children to each can vote for opposing political parties. Among the churches in the Vancouver area with infected parishioners, many are evangelicals.

People resistant to vaccines also cover the entire socioeconomic spectrum. While some outbreaks have been linked to richer enclaves, rural Washington shows some of the lowest immunization rates.

The spokeswoman for the Washington Health agency, Danielle Koenig, said that this is partly due to access. Some counties in Washington have so few places that they can administer these vaccines that parents do not have.

But despite knowing which schools and regions in Oregon and Washington have low vaccination rates, there is a growing sense that public health agencies are losing the battle against "anti-avengers," the label attached to people more fervent against vaccines.

Koenig noted that Washington's vaccination rates have remained relatively stable over the past decade, but that level is below what health officials want it to be.

Oregon, too, suffers from chronically low vaccination rates.

The Washington State Department of Health provides education and messages about the benefits of vaccines. Officials remind parents that the majority choose to vaccinate their children.

Throughout the state, seven out of every 10 people are fully vaccinated.

"While it seems to be a strong online argument, it's really just a small percentage of people who are not choosing vaccines," Koenig said.

But a statewide average does not necessarily help Clark County, where only 77.4 percent of all public students have completed their immunizations.


The laws of Washington and Oregon require that public school students be vaccinated to receive an education, for the most part.

Both states allow a significant margin for parents to obtain an exemption.

Oregon and Washington, among many states, allow parents to enroll their children in school without vaccines by claiming a philosophical, as well as religious and medical objection.

To balance that indulgence, a parent must first meet with a health care provider. The intention was that perhaps a doctor could explain the serious risks in choosing not to vaccinate.

But in Washington, parents can also choose not to attend that meeting if they claim they have a religious objection to any form of health care intervention. In Oregon, you can choose to watch a video produced by the state.

The compensation is that children who lack the required immunizations can be excluded from school, since they have been in the Evergreen School District during the measles outbreak.

According to district spokeswoman Gail Spolar, more than 100 students do not have the necessary immunizations. Of them, the great majority have philosophical or religious exemptions.

The school district is trying to send work home so students can keep up with the school while they stay home, Spolar said, but can not be sure that they will continue on the right track. Once they are allowed to return to school, the staff tries to help them catch up.

Spolar said that school officials share the same problems as anyone trying to control the measles outbreak, but that the messages in favor of vaccination are not the work of the school district.

Parents and guardians file immunization paperwork when enrolling children in school, and it would be impossible to try to convince each of the costs of not getting vaccinated, Spolar said.

"That's not something we're going to do," he said.

Instead, they focus on the management of the current outbreak. Spolar said not even 20-year veterans of the district can remember an outbreak like this, so they had to learn to control it on the fly.

The school district is sending letters and emails in several languages, placing posters in schools, closing doors against unannounced visitors. The learning curve is steep, so any conversation about whether this situation will be commonplace in the future is left for later, Spolar said.


But at the county health office, Melnick is ready.

"We need a cultural change here and a broad community consensus on this before this changes."

He expects the outbreaks to get worse before they get better. The last confirmed case of measles in Clark County was 2011: two children had the disease. In 2015, the first person to die of measles in 12 years was in Washington.

Multnomah County had a case of measles last summer, and Clark County had a suspicious case that could not be confirmed.

Meanwhile, mumps and chickenpox, which children often get vaccinated at the same time as measles, have become more frequent.

Opponents of vaccination point to the low number of people hospitalized or dying of measles as a sign that the risk is exaggerated. Only one person has been hospitalized so far in the current outbreak. But Melnick argues that one in 30 is higher than it should be.

Especially when the hospitalization comes from a disease that was declared eliminated from the USA. UU In 2000 and it is expected that it does not affect any person every year.

"If the airline industry crashed two jumbo jets every year, I think people would be afraid to fly," Melnick said.

"Its a big problem."

For more information:

Measles outbreak in the Vancouver area: where you could have been exposed

Measles outbreak in the Vancouver area: this is what you need to know

– Molly Harbarger

[email protected]

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