Minnesota measles outbreak linked to anti-vaccine rhetoric hits 50 cases

A measles outbreak in Minnesota that has been linked to anti-vaccine rhetoric in an immigrant community has surpassed 50 cases — the largest in the state in almost three decades, according to state health officials.

The Minnesota Department of Health (MDH) said 51 people have been sickened in the outbreak so far, mostly in Hennepin County, which encompasses Minneapolis. The vast majority of patients have been unvaccinated children of Somali descent, a result of Somalis in Minnesota being targeted by anti-vaccine activists who have stoked fears about higher rates of autism among children in the community.

According to recent reports, these activists have included Andrew Wakefield, the researcher who lost his medical license in the United Kingdom over a discredited 1998 study suggesting a link between vaccination and autism.

“We’ve been aware for many years that the Somali community is the target of misinformation related to vaccines,” MDH spokeswoman Kate Awsumb told Infectious Disease News.

In response, Awsumb said the MDH has been working with community leaders and health care providers to dispel myths about vaccines and circulate accurate information.

Still, the autism fears were fanned during a recent meeting in Minneapolis hosted by anti-vaccine activists in which some physicians expressed concern that the activists were pushing scientifically discredited claims about the measles, mumps and rubella (MMR) vaccine in a community in the midst of a measles outbreak.

According to a Washington Post story that described the meeting, physicians “were interrupted by boos and yelling,” with the mother of a son who was diagnosed with autism shouting that she wanted to know if vaccines were safe and telling a pediatrician who addressed the crowd, “You don’t know what you are talking about.”

James Cherry
James D. Cherry

“I’ve been reading a lot about ‘fake news’ and how people would rather believe it than the truth. They’re not receptive to what the facts are. The question is, what should people do?” James D. Cherry, MD, MSc, distinguished research professor of pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles, and attending physician in pediatric infectious diseases at Mattel Children’s Hospital UCLA, said in an interview with Infectious Disease News.

Cherry said physicians might want to start by changing how they address scenes like the one described in the Washington Post story.

“I think that the mistake physicians make is they stand up and say vaccines don’t cause autism. They start on that part, which is not the way to do it. You want to start with what the risks of the disease are,” Cherry said.

For instance, as many as one out of every 20 children infected with measles will get pneumonia and about one or two out of every 1,000 will die, according to the CDC. Cherry said physicians should also warn parents about the risk of subacute sclerosing panencephalitis (SSPE), a 100% fatal complication of measles. SSPE affects as many as one in 609 patients infected before the age of 1 year, according to a recent study by Cherry and colleagues.

“Sometimes physicians are called upon to speak, and they don’t know enough about the subject,” Cherry said.

Although the Americas have not had an endemic case of measles since 2002 and the U.S. has been declared free of the disease since 2000, it remains common in other parts of the world. Travel-related outbreaks still occur here, such as the one that started in Disneyland theme parks in 2014. Recently, health officials warned that a surge in European measles cases was being driven by gaps in vaccination coverage.

Cherry said several factors have played a role in the anti-vaccine movement. “No. 1,” he said, “are people who make money from it. Andrew Wakefield is the prime example. He significantly contributed to what’s happened in Minnesota. He met with them. It’s alternative facts. And if people want to believe them, they believe them.”

It is the largest measles outbreak in Minnesota since 1990, when there were 460 cases and three deaths, Awsumb said. According to her, another ethnic group — the Hmong community — was disproportionately affected by that outbreak. The current outbreak is almost as large as the total number of measles cases in the U.S. in 2016 (61) and 2015 (70).

Autism fears were addressed in a 2013 study by researchers at the University of Minnesota, who found that Somali children in Minneapolis were about as likely as white children to be identified with autism spectrum disorder (ASD), although both groups had higher rates than black and Hispanic children and the rates were higher than most communities where ASD has been tracked by the CDC. Also, Somali children with ASD were more likely than all other racial and ethnic groups in Minneapolis to also have an intellectual disability, according to their report.

Amid pressure from activists, the MMR vaccination rate among children of Somali descent has dropped from 92% in 2004 to 42% in 2014, according to the MDH. But Awsumb said the MDH has seen an increase in the number of Somali children receiving the MMR vaccine from about 30 doses a week to around 500 doses per week.

“Our program staff, including our Somali outreach workers, worked closely with community leaders, religious leaders and health care providers to provide the community with accurate information and dispel myths and continue to work together during this outbreak,” she said.

According to the CDC, one dose of the MMR vaccine is about 93% effective at preventing measles, and two doses is around 97% effective. The CDC recommends children get their first MMR dose between the ages of 12 and 15 months and the second dose between the ages of 4 and 6 years, but the MDH has recommended an accelerated vaccination schedule, a common measure in an outbreak.

Graph showing decline in measles vaccination
This graph shows the decline in the measles vaccination rate among children of Somali descent born in Minnesota.
Source: Minnesota Department of Health

The MDH says children over age 1 year who have not been vaccinated and adults born after 1956 who have not had measles or been vaccinated should receive the MMR vaccine as soon as possible. It also recommends that children in the three affected counties — Crow Wing, Hennepin and Ramsey — and all Somali-American children in the state who have received their first dose of the MMR vaccine at least 28 days ago should get the second dose as soon as possible.

Cherry said parents whose children are not vaccinated are not always “hard-liner” anti-vaccine activists.

Near the end of the California measles outbreak linked to Disneyland, Cherry talked to a group of parents at a Los Angeles school where the measles vaccination rate was around 89%. He said most of the parents of unvaccinated children said they were just too busy to get them vaccinated, and the school did not realize they were not immunized.

“They just slipped through the cracks,” Cherry said.

Within 2 weeks, the immunization rate had gone up to 95%, he said. – by Gerard Gallagher

References:

CDC. Measles cases and outbreaks. 2017. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed May 10, 2017.

CDC. Measles vaccination. 2017. https://www.cdc.gov/measles/vaccination.html. Accessed May 10, 2017.

Minnesota Department of Health. MDH expands advice for measles vaccination to make sure more children in state are protected. 2017. http://www.health.state.mn.us/news/pressrel/2017/measles050417.html#contact. Accessed May 10, 2017.

University of Minnesota. Minneapolis Somali autism spectrum disorder prevalence project. 2013. http://rtc.umn.edu/autism/. Accessed May 10, 2017.

Washington Post. Anti-vaccine activists spark a state’s worst measles outbreak in decades. 2017. https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html?utm_term=.1ef0a43893dd. Accessed May 10, 2017.

Wendorf KA, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix302 .

Disclosures: Awsumb and Schultz work for the Minnesota Health Department. Cherry reports no related financial disclosures.

A measles outbreak in Minnesota that has been linked to anti-vaccine rhetoric in an immigrant community has surpassed 50 cases — the largest in the state in almost three decades, according to state health officials.

The Minnesota Department of Health (MDH) said 51 people have been sickened in the outbreak so far, mostly in Hennepin County, which encompasses Minneapolis. The vast majority of patients have been unvaccinated children of Somali descent, a result of Somalis in Minnesota being targeted by anti-vaccine activists who have stoked fears about higher rates of autism among children in the community.

According to recent reports, these activists have included Andrew Wakefield, the researcher who lost his medical license in the United Kingdom over a discredited 1998 study suggesting a link between vaccination and autism.

“We’ve been aware for many years that the Somali community is the target of misinformation related to vaccines,” MDH spokeswoman Kate Awsumb told Infectious Disease News.

In response, Awsumb said the MDH has been working with community leaders and health care providers to dispel myths about vaccines and circulate accurate information.

Still, the autism fears were fanned during a recent meeting in Minneapolis hosted by anti-vaccine activists in which some physicians expressed concern that the activists were pushing scientifically discredited claims about the measles, mumps and rubella (MMR) vaccine in a community in the midst of a measles outbreak.

According to a Washington Post story that described the meeting, physicians “were interrupted by boos and yelling,” with the mother of a son who was diagnosed with autism shouting that she wanted to know if vaccines were safe and telling a pediatrician who addressed the crowd, “You don’t know what you are talking about.”

James Cherry
James D. Cherry

“I’ve been reading a lot about ‘fake news’ and how people would rather believe it than the truth. They’re not receptive to what the facts are. The question is, what should people do?” James D. Cherry, MD, MSc, distinguished research professor of pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles, and attending physician in pediatric infectious diseases at Mattel Children’s Hospital UCLA, said in an interview with Infectious Disease News.

Cherry said physicians might want to start by changing how they address scenes like the one described in the Washington Post story.

“I think that the mistake physicians make is they stand up and say vaccines don’t cause autism. They start on that part, which is not the way to do it. You want to start with what the risks of the disease are,” Cherry said.

For instance, as many as one out of every 20 children infected with measles will get pneumonia and about one or two out of every 1,000 will die, according to the CDC. Cherry said physicians should also warn parents about the risk of subacute sclerosing panencephalitis (SSPE), a 100% fatal complication of measles. SSPE affects as many as one in 609 patients infected before the age of 1 year, according to a recent study by Cherry and colleagues.

“Sometimes physicians are called upon to speak, and they don’t know enough about the subject,” Cherry said.

Although the Americas have not had an endemic case of measles since 2002 and the U.S. has been declared free of the disease since 2000, it remains common in other parts of the world. Travel-related outbreaks still occur here, such as the one that started in Disneyland theme parks in 2014. Recently, health officials warned that a surge in European measles cases was being driven by gaps in vaccination coverage.

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Cherry said several factors have played a role in the anti-vaccine movement. “No. 1,” he said, “are people who make money from it. Andrew Wakefield is the prime example. He significantly contributed to what’s happened in Minnesota. He met with them. It’s alternative facts. And if people want to believe them, they believe them.”

It is the largest measles outbreak in Minnesota since 1990, when there were 460 cases and three deaths, Awsumb said. According to her, another ethnic group — the Hmong community — was disproportionately affected by that outbreak. The current outbreak is almost as large as the total number of measles cases in the U.S. in 2016 (61) and 2015 (70).

Autism fears were addressed in a 2013 study by researchers at the University of Minnesota, who found that Somali children in Minneapolis were about as likely as white children to be identified with autism spectrum disorder (ASD), although both groups had higher rates than black and Hispanic children and the rates were higher than most communities where ASD has been tracked by the CDC. Also, Somali children with ASD were more likely than all other racial and ethnic groups in Minneapolis to also have an intellectual disability, according to their report.

Amid pressure from activists, the MMR vaccination rate among children of Somali descent has dropped from 92% in 2004 to 42% in 2014, according to the MDH. But Awsumb said the MDH has seen an increase in the number of Somali children receiving the MMR vaccine from about 30 doses a week to around 500 doses per week.

“Our program staff, including our Somali outreach workers, worked closely with community leaders, religious leaders and health care providers to provide the community with accurate information and dispel myths and continue to work together during this outbreak,” she said.

According to the CDC, one dose of the MMR vaccine is about 93% effective at preventing measles, and two doses is around 97% effective. The CDC recommends children get their first MMR dose between the ages of 12 and 15 months and the second dose between the ages of 4 and 6 years, but the MDH has recommended an accelerated vaccination schedule, a common measure in an outbreak.

Graph showing decline in measles vaccination
This graph shows the decline in the measles vaccination rate among children of Somali descent born in Minnesota.
Source: Minnesota Department of Health

The MDH says children over age 1 year who have not been vaccinated and adults born after 1956 who have not had measles or been vaccinated should receive the MMR vaccine as soon as possible. It also recommends that children in the three affected counties — Crow Wing, Hennepin and Ramsey — and all Somali-American children in the state who have received their first dose of the MMR vaccine at least 28 days ago should get the second dose as soon as possible.

Cherry said parents whose children are not vaccinated are not always “hard-liner” anti-vaccine activists.

Near the end of the California measles outbreak linked to Disneyland, Cherry talked to a group of parents at a Los Angeles school where the measles vaccination rate was around 89%. He said most of the parents of unvaccinated children said they were just too busy to get them vaccinated, and the school did not realize they were not immunized.

“They just slipped through the cracks,” Cherry said.

Within 2 weeks, the immunization rate had gone up to 95%, he said. – by Gerard Gallagher

References:

CDC. Measles cases and outbreaks. 2017. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed May 10, 2017.

CDC. Measles vaccination. 2017. https://www.cdc.gov/measles/vaccination.html. Accessed May 10, 2017.

Minnesota Department of Health. MDH expands advice for measles vaccination to make sure more children in state are protected. 2017. http://www.health.state.mn.us/news/pressrel/2017/measles050417.html#contact. Accessed May 10, 2017.

University of Minnesota. Minneapolis Somali autism spectrum disorder prevalence project. 2013. http://rtc.umn.edu/autism/. Accessed May 10, 2017.

Washington Post. Anti-vaccine activists spark a state’s worst measles outbreak in decades. 2017. https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html?utm_term=.1ef0a43893dd. Accessed May 10, 2017.

Wendorf KA, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix302 .

Disclosures: Awsumb and Schultz work for the Minnesota Health Department. Cherry reports no related financial disclosures.