Measles Outbreak in Oregon & Washington
February 5, 2019
With the current outbreak of measles in WA and OR many parents are wondering is measles serious, how is vitamin A related, and what is a “live” vaccine?
Here are a few things you should know.
The primary public health concern is the contagiousness of measles. This little virus travels and it travels fast. Because the virus can stay airborne for about 2 hours it can infect a lot of people in a fairly short period of time. If no one was immune, every case of measles could infect 11-18 other people, and they could all infect 11-18 and so on and so on.
Those with the highest risk of serious illness from measles are pregnant women, infants under 12 months of age, and people with weakened immune systems. These groups of people live in our communities; they work, shop, play and seek healthcare at that same places that families with unvaccinated children do. And they have the right to feel safe and protected in their community. We can participate in their wellbeing and our own, by being immunized against measles and gently encouraging others to do the same.
People are contagious with measles for four days before the rash appears, and up to four days after the rash appears. That is over a week in most cases. During this period, they are visiting a large variety of places including schools, clinics, and even grocery stores before they even know they have the disease. The most common complications of measles include ear infections, pneumonia, and diarrhea. While encephalitis (brain swelling) is rare it is more common than death due to measles.
The reason people can say that children don’t die anymore from the measles is because in 2002 we eliminated measles in the US. Now that we are seeing more measles cases every year, statistically speaking, we will eventually see deaths from measles again. Again, it’s not that measles kills 1-2 children out of 1,000 cases, it’s that is causes a great deal of illness and often long-term disability in children who are infected.
Measles and Pregnancy
If you are not vaccinated, or immune to measles, try to avoid being with unvaccinated persons. Contracting measles during pregnancy increases the chances of miscarriage, premature birth and low birthweight. If you are thinking of becoming pregnant and are unsure of your immunity status you can ask your doctor to check your status with a blood test.
Even though the vaccine is what is known as a live vaccine, people who receive it do not shed the virus. If you have other children and are pregnant, they can be vaccinated, and it will not harm you or your unborn baby.
Vitamin A is not a protection against or cure for measles.
There is a link between severe vitamin A deficiencies and the complications of measles, primarily pneumonia, because measles causes a depletion of vitamin A in the body. However, children living in the US are not generally deficient in vitamin A as it is found in many foods, both animal and plant based. In addition, many of our cereals and dairy products are fortified with vitamin A.
The primary causes of vitamin A deficiency in children are: 1) mothers who are vitamin deficient and thus produce breast milk low in vitamin A, or 2) after weaning, young children consume diets that are deficient. Some children who are chronically ill and have anorexia or malabsorption conditions may also have insufficient levels of vitamin A. These are typically conditions found in the developing world and not in the US. Vitamin A does not offer any protective value against becoming infected with measles and would have very limited (if any at all) treatment value for the average child in the US.
Many people wonder what does live attenuated mean? Some vaccines are made by passing a virus though cell cultures (or eggs) until they can replicate well in that type of culture, but not in humans. The end result is a product that is weakened, or another word is, attenuated. These vaccines work very well because they create a long-lasting and strong immune response that is like that of a natural infection but doesn’t actually cause disease. This immunity usually lasts a life time and does not require boosters. The measles vaccine (MMR) causes a protective immune response in about 95% of children who receive it after the first dose. The one unfortunate exception to this form of vaccine is the oral polio vaccine which is no longer given in the US, or hardly anywhere in the world now. The History of Vaccines website explains different types of vaccines nicely.
The measles vaccine has been around for a long time now, since 1963 to be exact, and proven to be safe in millions and millions of people.
Viral shedding is an often-misunderstood concept by many. Shedding is just the spreading of disease normally though coughing or sneezing. The MMR vaccine does not shed at all. Some live vaccines like rotavirus, do shed small amounts that can be found in an infant’s stool, but it is not common and is too little to be passed on to others.
We must not let history repeat itself. Measles is not a harmless childhood right of passage. The MMR is a very safe vaccine and highly effective vaccine. Learn more about the MMR Vaccine.
10 things to know about pertussis (whooping cough) in Ashland, Oregon
September 17, 2017
- While most people are immunized in our community, we do not have enough children vaccinated in our schools to prevent pertussis from spreading. The threshold needed for herd immunity is 92-94% to prevent the spread of pertussis but in most Ashland schools the percent of children vaccinated is below 80%.
- In older children, teens and adults, pertussis may seem like a cold with a lingering but horrid cough. Young children and infants, or the children in our community who are recovering from cancer treatments may get very sick from pertussis. A pertussis infection can cause brain injuries or death in infants.
- The vaccine currently used (DTaP, TDaP) is a very safe vaccine. It was developed in response to some of the side effects (none were deadly or debilitating) that occurred after the whole cell pertussis vaccine (DTP) was given. DTP was phased out in the 1990’s.
- People in the community who are against vaccines, often cite the problems that followed administration of the DTP vaccine in order to convince people not to vaccinate. They are using old information that is not correct. Many of these people are not trained in vaccinology or even science. Multiple studies and decades of scientific research have gone into developing and assuring the safety of vaccines. Do what is best for your family and your community, immunize your children against pertussis.
- Pertussis comes in cycles every 3-5 years. An outbreak simply means we are having more cases than what is generally expected in the community.
- A pertussis infection does not give immunity for life. Please immunize your children even if they have had the infection in the past.
- Immunity in children from the vaccine wans prior to the recommended booster shot at age 11. If your children are immunized encourage your peers to do the same to protect those who may not be fully covered by the vaccine.
- The DTaP vaccines are 80% to 90% effective. Among kids who get all 5 doses of DTaP on schedule, effectiveness is very high within the year following the 5th dose – at least 9 out of 10 kids are fully protected. About 7 out of 10 kids are fully protected 5 years after getting their last dose of DTaP and the other 3 out of 10 kids are partially protected – protecting against serious disease.
- Pregnant women should be immunized at 27 weeks for each pregnancy. Study after study has shown there is no harm to the infant but protection is passed on. More importantly it means mom can’t give pertussis to her baby. Transmission of the disease from a family member is often the cause of infant deaths from pertussis. Cocoon your infant by making sure all family members are vaccinated.
- It is never too late to start vaccinating against pertussis. Tdap is for everyone 11 years or older, including pregnant women and DTaP is for children 2 months through 6 years of age.
- Learn more about Pertussis.
A Note From the Editor
February 11, 2017
This week there was a letter sent to the local high school and posted on social media that a representative of Ashlandchild.org is encouraging teens to get immunized without parental consent. This is simply not true.
While it is within a teen’s legal rights in Oregon to consent for their own vaccines (ORS 418.307 & 433.267), the editors and writers at Ashlandchild.org do not support or encourage teens 15 years and older being immunized without their parent’s consent. This is a family decision. The intent of the law is to provide access to children and teens in need of immunizations. It is not intended to foster sneaky or manipulative behavior by teens, healthcare providers or schools.
FluMist Not Recommended This Year by ACIP/CDC
For the last several years children and adults have had the option of getting the flu vaccine without getting the shot. This was accomplished through a nasal spray. After reviewing data from the last three years the live (LAIV) nasal mist vaccine was found to have low effectiveness. You can read more it on the CDC site.
Some people might use this discovery to reinforce their argument that vaccines don’t work. However you could look through another lens and see that vaccines are constantly being monitored and reviewed even after they are approved. And to get approved requires years of work and testing. Having a vaccine removed from the recommended list shouldn’t be cause for alarm, but rather, reassure us.
Getting your flu shot is something you do for your community, for your infants, and the elderly. Infants and the elderly are extremely susceptible to severe illness from the flu. If you are pregnant we highly recommend talking to your doctor about the flu shot. The flu vaccine is perfectly safe in pregnancy and will protect both you and your newborn.
Oh, and one other little thing………….the flu shot can’t give you the real influenza. It’s impossible.
Have a flu free winter!!
University of Oregon’s Meningitis Outbreak and a New Vaccine: What you should know to protect your teen.
The meningitis vaccine that is currently on the recommended vaccine schedule for teens does not cover the serotype (B) that caused severe illness and a death among the students of University of Oregon last winter. The current vaccine protects people against the serogroups A, C, W, and Y. The FDA has licensed two new vaccines for serotype B and approximately half of the UO students were vaccinated. Trumenba is a 3 dose vaccine and Bexsero a 2 dose series. These vaccines are currently only approved for people ages 10 through 25 years who are at increased risk for meningococcal meningitis. The vaccine was not approved by the CDC to be added to the recommended schedule or to be used routinely. It was only approved to for limited use. The vaccine for the other 4 serotypes (Menactra) is part of the recommended teen schedule.
That does not mean the vaccine is unsafe. It only indicates that the ACIP* and CDC do not wish to routinely recommend it at this time. Cost and a low number of cases per year are some of the factors the CDC considers when making these decisions. Further studies may also be needed. Parents will need to talk to their medical providers about receiving the vaccine if they have students attending college. Students who attend the University of Oregon will be vaccinated if they are at risk.
Who is at risk for getting meningococcal meningitis? Close contact is required for meningitis to spread or be acquired. The habits of college freshman who also tend to live close together in dorms, makes them the primary group at risk for the disease especially during an outbreak. Other high risk groups include those with certain medical conditions such as not having a spleen.
For more information see our page on meningococcal disease.
*ACIP is the Advisory Committee on Immunization Practices
Chickenpox Outbreak in Ashland: Should You Be Concerned?
December 18, 2014
“Chicken pox is no big deal” is what you will often hear people say. And while it’s true that chickenpox was once common and seldom serious it’s also true that on average 2 children died every week in the US from chickenpox before the vaccine.
Ashland, OR is currently experiencing an outbreak of this disease. Should you be concerned? The short answer is yes. Getting chickenpox is a fairly miserable experience and the outcome is unknown. Severe outcomes such as pneumonia can and do occur and are especially devastating for adults. Children younger than 1 and older than 15 are more likely to have complications from chickenpox.
But the most important point is that you don’t know who you might infect.
Chickenpox is contagious 1-2 days before the tell-tale rash appears.
- If you are pregnant please be especially cautious.
- Avoid “pox parties” and any known cases or homes where chickenpox has occurred.
- If you have a child with chickenpox you need to notify any pregnant women your child has been in contact with.
- Please call your doctor and try to avoid medical office waiting rooms.
- If you suspect chickenpox you need to notify your clinic or MD prior to arriving.
When this outbreak is all over you will hear people say. “Vaccines don’t work. Kids that were vaccinated got chickenpox too.” This is true.
Why? Because no vaccine is 100% effective. However, these children will have very mild cases with few lesions and most likely not suffer any long term consequences. The vaccine is 95% to 100% effective against severe cases of chickenpox.
Here’s an example of why some vaccinated people will get the disease. Let’s say you have 100 children and 10% are unvaccinated but the rest are vaccinated with a vaccine that is 90% effective. All the unvaccinated children (say 10 total) will get the disease but approximately 9 vaccinated children will also come down become with a very mild illness. In the case of chickenpox you can expect a short illness with about 9 lesions or sores. These children can now infect others. The other 81 children will not be affected.
Many people think that you have to be in direct contact with someone with chickenpox to get chickenpox. That’s only partly true.
The disease is actually airborne.
You breathe it in. You can also get it from touching the wet lesions of an ill person. Once the lesions have crusted over they are no longer contagious. As diseases go though, chickenpox is one of the more contagious ones.
A person with chickenpox is contagious from 1–2 days before rash onset until the lesions have crusted over. It takes from 10–21 days after exposure to the virus for someone to develop varicella. Centers for Disease Control and Prevention (CDC) studies state that 90% of the susceptible people (i.e. those unvaccinated) in a house with an infected person will also become infected with chickenpox.
If you or your child are exposed to chickenpox there is a window of 3-5 days where you can still get the vaccine and potentially be protected against the disease.
Getting chickenpox is not really a required childhood experience. Please be compassionate and consider the impact of spreading the disease whether intentionally or unintentionally.
For more information visit our page on chickenpox under Vaccine Info. Information about where to get vaccinated.
Ashland Child wishes you a pox free New Year.
The Oregon Immunization Exemption Law Now in Effect
The new non-medical exemption law is effective as of March 1, 2014. If you are seeking an exemption or simply wish more information about immunization in Oregon, visit the Oregon Public Health website to watch the Vaccine Education Module video.
If you do not wish to watch the video, you can see your provider who will provide you with the required education and certificate as well.
This flow chart (PDF) helps make sense of the options.
The Oregon Immunization Exemption Bill
The new Oregon Immunization Exemption Bill (PDF) SB 132 amends ORS 433.267, 433.273 and 433.284 and becomes operative on March 1, 2014.
Why is the bill needed?
- Oregon leads the nation in kindergartners whose parents have exempted them from vaccination requirements.
- Josephine and Jackson counties have non-medical exemption rates that are much higher than the state average, and they are rising. This year, for the 2012–13 school year, the state average exemption rate for kindergartners is 6.4%. Josephine County’s rate is 13.5%, up from 10.7% last year. Jackson County’s rate is 8.7%, up from 6.3%. High exemption rate will open Southern Oregon up to more outbreaks of vaccine-preventable diseases such as measles and pertussis.
What it does:
- The bill requires that parents seeking an exemption see a health care provider or watch a video and get a certificate, in order to make an informed decision.
What it doesn’t do:
- The bill does not take away the right to get an exemption or restrict religious freedoms. It merely removes the word “religious” and refers to the school immunization exemption as a “non-medical exemption.”
- It doesn’t force you to see a doctor. The option of taking an online course is available.
- It doesn’t force you to get vaccines to attend school or daycare.
Oregon Public Health Immunization Law