Experts urge vaccination as US measles cases top 1,000

Federal officials yesterday said US measles cases have reached 1,001, the first time since 1992 that cases have been in quadruple figures, while experts continued to urge vaccination and underscored the safety of the vaccine.

Health and Human Services (HHS) Secretary Alex Azar said in an HHS news release, "We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak."

He added, "The Department of Health and Human Services has been deeply engaged in promoting the safety and effectiveness of vaccines, amid concerning signs that there are pockets of undervaccination around the country. The 1,000th case of a preventable disease like measles is a troubling reminder of how important that work is to the public health of the nation."

"The measles vaccine is among the most-studied medical products we have and is given safely to millions of children and adults each year," Azar said. "Measles is an incredibly contagious and dangerous disease."

HHS said the Centers for Disease Control and Prevention (CDC) has taken several steps to tamp down cases, including those in 10 separate ongoing outbreaks across the country. The largest of these is occurring in New York City, with 566 cases as of Jun 3. In addition, Rockland County, New York, has confirmed 256 cases as of yesterday.

Among the response measures the CDC has implemented are a measles Incident Management Structure within its National Center for Immunization and Respiratory Diseases, resources for physicians, and outreach to rabbinical, camp, and medical associations to help spread clear and consistent messages. The agency has also deployed a field team to Rockland County.

HHS said the CDC has identified more than 1,500 people exposed to measles during airline travel. Measles was declared officially eradicated in 2000, but the CDC said last week that the country may now be in danger of losing that status.

How best to encourage vaccination?

In two commentaries yesterday in the New England Journal of Medicine, several US experts addressed the complexities of mandating vaccination to prevent diseases like measles.

In the first one, Julie Cantor, MD, JD, of the University of California Los Angeles School of Law, dissects the "bold experiment" of barring unvaccinated students from all schools in Rockland County and mandating measles, mumps, and rubella (MMR) immunization in the Brooklyn borough of New York City in response to those large outbreaks—and she warns that the efforts might at least partially backfire.

In response to New York City's approach, Cantor cites several legal issues to forced vaccination, including whether children and parents can be restrained, whether families that relocate from Brooklyn risk extradition, and if a second dose should also be mandated. She also asks why officials should wait for an outbreak when hot spots are predictable.

"In my view," she writes, "the option should be reserved for extraordinary cases, in which the risk of death or disability is overwhelming, after less intrusive options have been exhausted. Though the benefit is clear, I am not convinced that measles prophylaxis meets that test."

Cantor also argues that, even without forced vaccination, an order against attending school, for example, can be problematic. "A combative stance can stigmatize insular communities, like the Jewish sects tied to the New York outbreaks. Rocky rollouts in both areas of New York State, like changing previously announced orders or instituting bans that lack scientific support, do not inspire confidence. If vaccine hesitancy is linked to distrust of government, these missteps exacerbate that problem."

She also noted that, by May 29, New York City had issued 123 civil summonses for noncompliance with its order—evidence of defiance. And she says that emergency edicts might not even increase vaccination rates.

Cantor concludes that other measures might serve health officials' aims better.

"Law shifts culture best through incremental change," she writes. "To reset vaccination norms, state legislatures could lower the age of consent, eliminate nonmedical exemptions to school-entry vaccination laws, and develop oversight mechanisms for medical exemptions. The federal government could fund research on combating vaccine disinformation."

She says New York City's order, though well-intentioned, might have unintended consequences, like impairing government's relationship with citizens and undermining their sense of security.

The second commentary spotlights the issue of vaccinating teens and preteens over their parents' objection—such as when, in March, an Ohio high school senior in testimony before the US Congress argued for such a right.

The viewpoint authors—from the Richard M. Fairbanks School of Public Health and Robert H. McKinney School of Law at Indiana University, Indianapolis; the Department of Pediatrics, University of Washington School of Medicine in Seattle; and the Rollins School of Public Health at Emory University in Atlanta—likewise favor the rights of children and adolescents over their parents' rights, for the good of the public's health.

The experts conclude, "Allowing adolescents to consent to vaccination despite persistent parental resistance facilitates access to a medically recommended and evidence-based treatment. It promotes the minor's health, poses minimal personal risk, and offers substantial prosocial benefits, including reinforcement of the norm of vaccination and enhancement of community protection against the spread of dangerous and costly yet preventable diseases.

"Given such benefits, we believe that states should enact laws that expand both access to vaccines and the rights of minors who are at least 12 to 14 years of age to consent to vaccination."

See also:

Jun 5 HHS news release

Jun 5 N Engl J Med commentary on New York vaccination

Jun 5 N Engl J Med commentary on teen vaccination

Jun 3 NYC health update

Jun 5 Rockland County update

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