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After the Clark County outbreak, spreading measles education

Health officials, lawmakers, educators say new legislation, building trust and groundwork are key to improving vaccination rates

By Wyatt Stayner, Columbian staff writer

Published: May 5, 2019, 6:02am

5 Photos

Julie Scordino of Camas holds still as registered nurse Kent Slawson administers the MMR vaccine during a free vaccination clinic offered by Legacy Medical Group in Vancouver. Legacy offered vaccination MMR vaccination clinics in March as a low barrier opportunity for vaccinations. Alisha Jucevic/The Columbian Photo Gallery

All the windows in the bedroom were blacked out, Tom Perkins remembered, and there was a quarantine sign posted on the front door of his house in Smithfield, Utah.

Perkins was between 6 to 8 years old, from what he can remember, so it was between 1953 and 1955. He had contracted “red measles,” and couldn’t wear cotton or wool. Instead Perkins wore slick, silk-like clothing so his rashes wouldn’t be so irritating. Perkins was quarantined to his parent’s darkened bedroom, because his eyes were hypersensitive to light. The 72-year-old Vancouver resident described his fever as “tremendous.”

“I don’t know back then if they called it an epidemic, but there were quite a bit of kids who were missing school because of the measles,” Perkins said. His brother contracted measles right afterward.

In the decade before a measles, mumps and rubella vaccine became available in 1963 almost all U.S. children suffered through the measles before they turned 15, according to the Centers for Disease Control and Prevention. Three million to 4 million were infected each year, 48,000 were hospitalized, 1,000 contracted encephalitis, and 400 to 500 died.

The virus wreaked so much havoc that in 1978 the CDC set a goal to eliminate measles by 1982. That goal was finally achieved in 2000 when there had been “absence of continuous disease transmission for greater than 12 months,” according to the CDC.

Now, 65 years after Perkins subsisted on soup for two weeks, the United States is in the midst of its biggest measles outbreak since 2000.

Clark County accounted for 71 of the country’s more than 700 cases this year, which have spread across 23 states. By the time the outbreak was declared over last Monday, nearly 850 local students were temporarily excluded from school, and Washington spent more than $1 million to fight the virus.

Sixty-one of Clark County’s 71 measles patients weren’t vaccinated and another seven cases were unverified. The other three had one dose of the MMR vaccine, less than the two recommended doses.

In the 1950s Perkins didn’t have protection against measles, but the decision to vaccinate his children was easy.

“We’ve been blessed today to have the immunizations,” Perkins said. “The number of people who are negatively affected by immunizations are so low that I cannot believe parents will not inoculate. I wouldn’t want my kids, or my grandkids, or my great-grandkids, to go through all that. It can kill you.”

Yet vaccination rates in Clark County continue to lag. According to state data, only 78 percent of Clark County 6- to 18-year-olds have received the recommended two doses of MMR vaccine as of December, the most current data available.

That’s behind the 93 to 95 percent vaccination rate that’s needed to create “herd immunity”and prevent future outbreaks. Brianna Dannen, the co-chair for Clark County Immunization Coalition and a nurse for Public Health who heads their immunization program, said there’s no simple fix to the problem.

“I don’t have that magic bullet,” Dannen said. “I think it’s baby steps.”

Booster shot

One boost to MMR vaccination comes in the form of House Bill 1638, which was sponsored by state Rep. Paul Harris, a Vancouver Republican, and state Rep. Monica Stonier, a Vancouver Democrat. HB 1638 will eliminate personal and philosophical exemptions for the MMR vaccine for attendance in public and private schools and licensed day care centers. The bill passed the 2019 Legislature, and Gov. Jay Inslee is expected to sign it.

Similar California legislation enacted in 2015 has raised the state’s vaccination rates for children entering school by nearly 5 percentage points. County Health Officer Dr. Alan Melnick called HB 1638 “a powerful statement about how we need to protect children in the community and schools, and that goes a long way to change how we look at the world.”

He said policy changes around smoking tobacco have had lasting impacts, and he thinks the vaccination legislation will do the same in Washington.

“Sometimes policy changes, besides being policy changes, actually change the culture and norms about how we look at this,” Melnick said. “I’m hoping the vaccine policy change will not only get rid of the personal exemption, but I’m hoping the longer that’s in effect the more our cultural norms will change about getting vaccinated.”

The county’s outbreak brought measles and vaccination misinformation to the forefront for Public Health. Dannen said it’s easy to see how people can have difficulty deciphering what to believe with so much misinformation readily available through the internet.

“It comes down to fear. Parents are afraid to vaccinate their kids,” Dannen said. “They’re misinterpreting the risk of the vaccine, adverse reactions, versus if their child would actually get sick and the outcomes they could have from that. A lot of that is our natural tendency to have anecdotal evidence play as big of a role or a bigger role in our minds than the actual data shares. If somebody shares a statistic, that doesn’t make as much of an impact as if somebody shares a story. And in this digital age of social media, it’s easy to share something on Facebook, and not as easy to validate those stories when they’re anecdotal.”

Melnick explained the outbreak taught him more about the importance of communication, especially with parents who are hesitant about vaccines. Melnick said he’ll work with local faith leaders to build trust and reach vaccine-hesitant folks.

“I’m still learning this, but I think we need to do a better job of listening to vaccine-hesitant parents,” he said. “It’s easy to become judgmental of folks who are not vaccinating, and they’ve been subject to pretty sophisticated misinformation that’s been going on, and they care about their kids. I’m continuing to learn about how to listen better to people who are vaccine hesitant and do some better communication with folks who are vaccine hesitant.”

Project pilots change

Even before the measles outbreak started with a confirmed case on Jan. 3, Clark County Public Health had started working on a pilot project aimed at improving local immunization rates.

Using money from a grant, Dannen started working with Evergreen Public Schools last summer. In the 2017-18 school year, only 53.9 percent of Evergreen students had all of their immunizations complete.

That was the lowest percentage in Clark County and the seventh-lowest in Washington. But only 5.8 percent of students had a vaccination exemption on file for personal, medical or religious reasons. That put 40 percent of students out of compliance. That has already decreased this year 25 percent, according to statistics from February.

Evergreen has also seen a decrease of students who were out of compliance with the MMR vaccine, which requires two doses. Evergreen saw out-of-compliance rates for the MMR vaccine drop from 7.3 percent to 3.3 percent from Jan. 18 to Feb. 8, and also saw students with an exemption on file for the MMR vaccine drop from 12.6 percent of students to 4.1 percent of students in the same time range.

Dannen’s work with Evergreen, which has been aided by Mercy Corps volunteers, has been focused on going through Evergreen student’s vaccination records, organizing those records and inputting records into a system if they’ve been left out. In the coming weeks, there will be online surveys sent to parents of out-of-compliance students to find out why their kids are not immunized.

“We don’t know if those kids are (listed as) out of compliance and (actually) immunized, or out of compliance and really should have exemptions on file,” Dannen said. “We wanted to be able to work with the school and help them with that rate, and evaluate why are kids out of compliance with immunization requirements. … It helps us see if there’s pockets of kids who are unimmunized and are at high risk for having an outbreak in that school setting.”

Evergreen schools spokesperson Gail Spolar said that the program should help create continuity and a uniform system for vaccination record-keeping across the district’s 37 schools. The survey also should help Evergreen discover why so many students are not in compliance.

“That will give us some of those next steps to help target and assist families who want to get in compliance,” Spolar said. “Maybe there’s difficulty they’re having in getting their students vaccinated or understanding what vaccines are needed or any of those processes. We’re really looking to the survey to help us pinpoint those other problem areas.”

Booster shot

Project pilots change

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