Measles Hysteria: 2015

Mark F. Blaxill

Health Choice

February 20, 2015

• Part 1: Why measles is no longer a public health threat in the United States

• Part 2: The Disney land measles outbreak and its aftermath

PART 1:WHY MEASLES IS NO LONGER A THREAT IN THE U.S.

The U.S population risk of dying from measles has fallen essentially to zero during the 20th century, for one major and one minor reason

1. Most important, measles long ago became a “self-limiting infection of short duration, moderate severity, and low fatality.”1 Death rates among those infected fell to very low levels

2. Of lesser importance, wild-type measles cases have also fallen to very low levels following the introduction of the live virus measles vaccine

Since 2006,

• There have been over 1500 cases of wild-type measles in the U.S.

• There have been zero deaths from wild-type measles (the last in 2003)2

• Over 80 cases of deaths related to measles containing vaccines have been reported to VAERS3

1. Alexander D. Langmuir et al., The Importance of Measles as a Health Problem, 52 AM. J. PUB. HEALTH 1, 1 (1962).2. CDC spokesperson Helen (Amy) Rowland to Health Choice , January 30, 20153. Search for measles-containing vaccines, vaccination years 2006-2015 and death

http://www.medalerts.org/vaersdb/index.php

Summary points

• The hysteria over measles is unfounded. Measles is not Ebola• Measles has long since ceased to be a dangerous illness for healthy

children. Most adults born before the mid-1960s acquired measles in childhood and experienced it as a minor inconvenience

• The predominant experience of measles infection as a subclinical illness caused by live-virus vaccine injections has made wild-type measles very rare and easier to fear. Measles should not cause panic

• The measles vaccine virus can shed and cause infections in unhealthy children. Vaccinees should avoid those at health risk of viral infections. Measles vaccination to protect the ill is not a civic duty

• Measles-containing vaccines like MMR now cause many more deaths than measles

• The “Disneyland measles” episode is neither larger nor more serious than other recent outbreaks

Part 2: The Disneyland Measles Outbreak and it Aftermath

• An unknown individual (presumed to be an international traveler) infected with measles visited Disneyland around December 17-20, 2014.

• Approximately 40 California residents (and a smaller number of out-of state residents) were exposed to measles and infected during this period. These ~50 original cases eventually infected about 100 more, mostly California residents

• The CDC was first notified of these new cases in early January and began publicizing the outbreak aggressively soon after

• Intensive media coverage commenced in late January (January 21-24), peak coverage was reached in early February (February 3-6) and continued until month-end

• However, by mid February, measles infections were no longer spreading. The last reported California case connected to Disneyland caught the virus around February 20

• Prompted by the media hysteria over measles, a new outbreak of vaccine anti-exemption legislation was launched. In 11 states, legislators introduced new bills revoking exemption rights starting with a bill filed in Oregon on January 20th

• Four of these bills (the earliest ones introduced) have been withdrawn or tabled in the face of strong grassroots opposition

The origins of the outbreak

“On January 5, 2015, the California Department of Public Health (CDPH) was notified about a suspected measles case. The patient was a hospitalized, unvaccinated child, aged 11 years with rash onset on December 28. The only notable travel history during the exposure period was a visit to one of two adjacent Disney theme parks located in Orange County, California. On the same day, CDPH received reports of four additional suspected measles cases in California residents and two in Utah residents, all of whom reported visiting one or both Disney theme parks during December 17–20. By January 7, seven California measles cases had been confirmed…

“The source of the initial Disney theme park exposure has not been identified. Specimens from 30 California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines, but has also been detected in at least 14 countries and at least six U.S. states in the last 6 months

Annual attendance at Disney theme parks in California is estimated at 24 million… including many international visitors from countries where measles is endemic. The December holiday season coincides with the exposure period of interest…. International travel to countries where measles is endemic is a well-known risk factor for measles, and measles importations continue to occur in the United States”

Source: MMWR Feb 20, 2015 /64(06);153-154

By late January, CDC was publicizing reports from a “multi-state outbreak linked to an amusement park in California”; by mid March, new reports had subsided

Date of report Total cases New reports

All US cases CA cases All US reports CA reports*

(as of 1/7)MMWR Feb 20, 2015 /64(06);153-154

9 7 9(12/17-1/7)

7

1/23/2015 (as of 1/21)http://emergency.cdc.gov/han/han00376.asp

51 42 42(1/7-21)

35

2/13/2015 (as of 2/11)MMWR Feb 20, 2015 /64(06);153-154

125 110 74(1/21-2/11)

68

3/2/2015 (as of 2/27)http://www.cdc.gov/measles/multi-state-outbreak.html

140 125 15

(2/11-27)

15

3/9/2015 (as of 3/6) 142 126 2 (2/27-3/6)

1

3/16/2015 (as of 3/13) 145 129 3(3/6-13)

3

3/23/2015 (as of 3/20) 146 130 1(3/13-20)

1

3/30/2015 (as of 3/27) 146 130 0(3/20-27)

0

*CDC weekly reports lag behind the California DPH reports

As of mid-February, the Disneyland outbreak had largely run its course, with very few new measles rashes

CDC MMWR Early Release: February 13, 2015. Number of confirmed measles cases (N = 110), by date of rash onset — California, December 2014–February 2015

Confirmed reported cases in California residents from the Disneyland measles outbreak stopped increasing in early March; new case reports dropped to zero after March 13

0

20

40

60

80

100

120

140

Source: California Department of Public Health, Measles Surveillance Updates: http://www.cdph.ca.gov/HealthInfo/discond/Pages/MeaslesSurveillanceUpdates.aspx

Cases exposed at Disneyland (40)

Cases directly linked to a Disneyland case (41)

Unknown link, but presumed Disneyland connection (50)

As of mid-March, it was clear the Disneyland measles outbreak had stopped spreading by February 20th

“California Measles Surveillance Update: March 20, 2015”

“Since December, 2014, there have been 133 confirmed measles cases reported in California residents.

• “No new confirmed cases have been reported to CDPH since the publication of the last report on March 13, 2015.

• “The outbreak will be considered over when 42 days have elapsed from the end of the infectious period of the last known B3 measles cases that was a not a new importation. As of today, that date will be April 17, 2015.”

Pinpointing key milestones for the last California known measles case

• March 6: end of the infectious period (42 days before April 17)

• March 2*: rash appears (4 days before end of infectious period, confirmed on 3/27)

• February 26: beginning of infectious period (4 days before rash onset, estimated)

• ~February 20: approximate date of last known infection (estimated)

* The March 2nd date of rash onset for the last confirmed case was confirmed by CDPH in the March 27th update

Measles hysteria in the media was peaking as the outbreak was ending and a push to restrict vaccine exemptions had begun

0

20

40

60

80

100

120

2014-03-30 - 2014-04-05

2014-05-25 - 2014-05-31

2014-07-20 - 2014-07-26

2014-09-14 - 2014-09-20

2014-11-09 - 2014-11-15

2015-01-04 - 2015-01-10

2015-03-01 - 2015-03-07

First week of February: • headlines peak • new cases near zero

“Google trends” index for news headlines on “measles”

Third week of February: • Headlines still strong, • Last new case

Jan 20-Feb 20• 8 state bills filed to

revoke exemption rights

State legislators seized on the publicity around the Disneyland measles outbreak as an occasion to attack longstanding vaccine exemption rights

Oregon Senator to introduce bill to eliminate 'personal belief' exemption for vaccines

The "personal belief" exemption to vaccinations may soon be history in Oregon, which has the highest opt-out rate in the country.

Sen. Elizabeth Steiner Hayward is sponsoring a bill to eliminate exemptions for nonmedical reasons, including personal or religious beliefs.

Lawmakers in California and Washington already introduced similar legislation earlier this week, amid an outbreak of measles originating at Disneyland.

Steiner Hayward said her bill would apply to all vaccines, not just the measles-mumps-rubella shot.

Source: Portland Business Journal, February 5, 2015

Starting with Oregon, state bills seeking to revoke exemption rights have been launched in 11 states State Bill Date filed Targeted

exemptionsStatus

Oregon SB442 1/20/15 PhilosophicalReligious

WITHDRAWN

Washington HB2009 2/6/15 Personal belief WITHDRAWN

New Mexico HB522 2/9/15 Religious TABLED

Maryland HB687 2/12/15 Religious WITHDRAWN

Vermont S87H212

2/12/152/13/15

PhilosophicalPhil/religious

ON HOLDON HOLD

California SB277 2/19/15 Personal beliefReligious

Pending

Illinois SB1410 2/20/15 Religious Pending

Rhode Island S381 2/25/15 Religious Pending

Maine LD606/HP419 3/3/15 Philosophical Pending

New Jersey S1147/A1931 3/9/15 (2nd reading) Religious PASSED Sen Comm

North Carolina SB346 3/19/15 Religious Pending

Progress on four of the earliest bills have been halted in the face of strong grassroots opposition

Other state bills seek to restrict exemption rights

State Bill Date filed Exemptions restriction Status

Minnesota SF380/HF393 1/29/15 MD certification required for PBE

PASSED Senate Committee 3/23

Texas HB1674 2/19/15 MD counseling required for conscientious andreligious exemptions

Pending

Maine LD471/HP310 2/24/15 MD certification required for PBE

Pending

Organizations opposing exemption bills

• Oregon: No on SB442, Yes on Medical Freedom http://www.noonsb442.com/

• Washington: no known formal organization

• New Mexico: no known formal organization

• Maryland: no known formal organization

• Vermont: Vermont Coalition for Vaccine Choice http://www.vaxchoicevt.com/

• California: No on SB447, Keep Medical Freedom for California (Facebook)

• Illinois: SB1410 Restricting Exemptions in Illinois (Facebook)

• Maine: Maine Coalition for Vaccine Choice http://mainevaxchoice.org/

• Minnesota: Vaccine Safety Council of Minnesota http://vaccinesafetycouncilminnesota.org/

• New Jersey: no known formal organization

• North Carolina: North Carolina Parents for Vaccine Rights, North Carolina People for Vaccine Choice (Facebook)

• Texas: Texans for Vaccine Choice http://www.texansforvaccinechoice.com/