Iowa hasn’t seen a measles case since 2011. But public health officials say it isn’t a stretch to think that the outbreaks happening in states across the country could occur here.
“Measles in particular is very easily transmissible,” said Doug Beardsley, director of the Johnson County Public Health Department. “And in an unvaccinated population, the potential goes up.”
More than 84 people from 14 states were reported to have measles during the first month of 2015, according to the Centers for Disease Control and Prevention. Most of these cases are part of a large, ongoing outbreak linked to Disneyland Resort in Anaheim, Calif.
But there also were a record number of measles cases during 2014 — with 644 cases from 27 states reported, according to the CDC. This is the greatest number of documented cases since measles was declared eliminated in the United States in 2000.
Measles is a highly contagious respiratory disease caused by a virus. It spreads through the air through coughing and sneezing.
Symptoms include a fever, runny nose, cough, red eyes. and sore throat, and is followed by a rash that spreads all over the body, according to the CDC.
The CDC, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians have urged parents to vaccinate their children.
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“Delaying vaccination leaves children vulnerable to measles when it is most dangerous to their development, and it also affects the entire community,” said Dr. Yvonne Maldonado, vice chair of the AAP Committee on Infectious Diseases, in a statement. “We see measles spreading most rapidly in communities with higher rates of delayed or missed vaccinations.”
Measles still is common in many parts of the world and cases are often imported, the CDC said. When the disease reaches the United States, it spreads easily when there are groups of unvaccinated people.
“We have the luxury of debating immunizations in this country in this day and age,” Beardsley said, pointing out that tens of thousands of people died from measles before there was a vaccination. “That doesn’t happen anymore. That’s a big testament to the effectiveness of the vaccine that we’re able to have generational amnesia.”
Exceeding national averages
Immunization rates in Iowa are consistent with or exceed national averages, according to the Iowa Department of Public Health.
Don Callaghan, bureau chief of the IDPH’s immunization program, said that in 2013 94 percent of children in Iowa received a vaccination for measles, mumps and rubella compared with the national average of 91.9 percent.
“But just because we’re above the national average doesn’t mean we won’t ever get a case of measles in Iowa,” he cautioned.
There are still pockets within communities with unvaccinated or undervaccinated populations, increasing the risk for outbreaks of diseases.
Statewide, the immunization rate for CDC recommended vaccines for 2-year-olds was 71 percent in 2013, the most recent data available, according to IDPH’s annual vaccination report. That number steadily has increased since 2010, when it sat at 69 percent.
IDPH officials anticipate the 2014 report to be released in March.
In Linn County, rates were above the state average in 2013, at 74 percent. But Johnson County shows an immunization rate of 37 percent — well below the state average.
And those numbers have fallen from 59 percent in 2010.
But Johnson County’s Beardsley said the numbers on the state report can be misleading.
Immunization rates are calculated from a statewide database. Some county public health departments input the numbers while some counties, including Johnson, rely on providers to input the information. That means some counties have more immunization records in the database than others.
Audits for Johnson County schools estimate that 96.8 of the kindergarten-through-12th-grade population has been vaccinated, Beardsley said. About 99.2 percent of enrolled students statewide were compliant with state law, according to IDPH.
But Beardsley noted that there has been an increase in religious exemptions in Johnson County, which have risen from 27 in 2000 to 313 in 2013. Parents only must have a signed and notarized form to obtain a religious exemption, he said, adding he believes that exemption form can be abused.
Part of the problem, health experts said, is a number of unsubstantiated claims that have scared parents into not vaccinating their children, including the belief that vaccines can cause autism.
“There’s so much bad information out there,” said Heather Meador, a senior public health nurse for Linn County Public Health. “We can be our own worst enemies.”
Meador said it’s important for health officials and providers to educate parents about the safety of vaccines.
“Nothing has been studied as much as immunizations,” she said.
Barb Neitzel-Schneider, a nurse practitioner with the UnityPoint Health pediatrics clinic in Hiawatha, said over the years she’s had to calm many anxious parents’ fears.
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“Years ago, parents were concerned about preservatives in vaccines,” she said. “Those have been taken out of vaccines. Now parents are concerned about the number of vaccines recommended at one time at such a young age.”
Neitzel-Schneider said she once had a parent whose questions were very specific and complicated that she had to write a letter to the manufacturer to get answers.
“But the parent was satisfied with that and now her child is vaccinated,” she said.
For the holdouts, Neitzel-Schneider has them sign a form stating that all their questions have been answered and they still have decided not to vaccinate their children, which she said can convince parents to change their minds.
If they still opt out of vaccinations by the time the child turns one-years-old, that family is asked to leave the practice, which is a systemwide policy.
Neitzel-Schneider said she has had to ask families to leave, and while that’s hard, it’s important to keep the other children healthy — especially infants too young to receive vaccinations.
“Immunizations are the foundation of pediatric health, we want kids to grow and develop well,” she said.