It sounds ludicrous that measles, a disease that has been preventable through vaccination for decades, may soon be making a comeback right here in Texas. But thanks to an increase in the number of children who are not being vaccinated these days, an outbreak may be just around the corner.
In a paper recently published in the journal PLOS Medicine, Peter Hotez, an infectious disease researcher at Baylor College of Medicine in Houston, argues that because of the large number of schoolchildren who are not being vaccinated in Texas, the situation is ripe for a large-scale measles outbreak starting in the spring or winter of 2018.
If it happens, the outbreak would make the 2014 Disneyland measles epidemic (after more than 100 people got the disease, it was found that unvaccinated kids helped fuel the outbreak, according to the L.A. Times) look like nothing in comparison, Hotez contends.
Before the measles vaccine was introduced in the early 1960s, measles epidemics regularly swept through communities every two to three years in the winter and spring. Each year about 500,000 people in the United States contracted the highly contagious airborne disease, according to the Centers for Disease Control and Prevention. Roughly 500 died from the disease annually, while more than 4,000 got measles encephalitis, which could cause deafness and neurological damage. About 20 million people still get the disease each year, but the cases are mostly in Africa and Asia. Since the advent of the measles vaccine, the disease has lost its footing in the United States.
So why does Hotez believe Texas is in the crosshairs? Partly because since 2003 Texas has allowed parents to choose not to vaccinate their children for non-medical reasons. Most states let parents choose not to vaccinate their children for specific religious reasons, but, as Science pointed out, Texas is one of a handful of states that also let people out of having their kids get all their shots based on broader philosophical excuses. (Texans can only dodge getting the required shots for their dogs based on medical exemptions, though, so don't even try the philosophical angle with your vet.)
Right now, about 45,000 of the 5.5 million children attending public, charter and private schools in Texas opted out of school vaccination requirements based on "conscientious" (i.e., not medical) reasons, according to the Texas Department of State Health Services. That's an increase of almost double the non-medical vaccine exemptions in 2010 and 19 times the number of students who were not getting vaccines for personal (or parental) reasons in 2003, the first year a state law allowing parents to have their children opt out went into effect.
Despite this loophole, children in Texas are still vaccinated at a pretty high rate — more than 97 percent. The problem, as Hotez sees it, is that the number of children who are not being vaccinated because of personal beliefs has soared since a law allowing this exemption went into effect in 2003. Measles tends to resurface first when vaccination rates drop below 95 percent.
Of course, the situation isn't necessarily as dire as it initially sounds. It will take some real effort to nudge the vaccination rate down two percentage points, and other parts of the country with even lower rates haven't seen massive measles epidemics, as immunologist Diane Griffin of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, pointed out in Science.
On top of that, the Texas climate seems to be ripe for the anti-vax movement. Andrew Wakefield, the infamous British former doctor who is seen as one of the founders of the granola-crunching, my-kid-is-vegan-but-not-vaccinated movement, has been ensconced in Austin for years. He came to notoriety after he published a paper in The Lancet in 1998 that claimed a connection between the MMR vaccine — a vaccine used to prevent measles, mumps and rubella — and autism, freaking out a lot of parents permanently even though the study was subsequently retracted and Wakefield was banned from practicing in the United Kingdom.
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It seems like Wakefield's presence in Texas has had a, well, infectious quality. In 2015, after state Representative Jason Villalba, a Dallas Republican, filed a bill proposing to scrap the non-medical exemptions rule, a lot of people got really angry on social media and then a political action committee, Texans for Vaccine Choice, sprang into life. The bill never even made it out of committee, and Villalba had a rough primary campaign in 2015.
This hasn't stopped Texas legislators from pushing to close this loophole in the state's vaccine policy in the upcoming session — including a bill that would make parents take an online course before choosing not to vaccinate their kids, one that would require discussing opting out with a doctor, and a bill that would simply allow parents to know the rate of vaccinated children at their kid's school.
But getting any of this through the Legislature is another matter entirely.
In the meantime, those with kids may want to start considering making shot records mandatory for playdates and birthday parties. Or, you know, you could just get your kid vaccinated.