Measles, Mumps and Rubella Vaccine

A Measles, Mumps and Rubella (MMR) vaccine sat on a countertop at a pediatrics clinic in Greenbrae, Calif. Two doses of the measles vaccine are about 97% protective, and one dose is about 93% effective.

By Pamela Bailey and Gonzalo Bearman

Through Dec. 5, there were 1,276 cases of measles in the United States. The virus, declared eliminated from the U.S. in 2000, made a resurgence this year. A recent Virginia Health Department advisory cautioned about a measles-infected person at Richmond International Airport; earlier this year, one traveled through Dulles International Airport and several other places in Northern Virginia.

Measles in the U.S. is largely imported via international travel. The disease then spreads in domestic communities with low vaccination rates. Much focus was on a large outbreak centered in New York, but 31 other states, including Virginia, reported measles. One hundred twenty-four cases required hospitalization. All of this was preventable with the measles vaccination.

Vaccines are safe. A National Vaccine Injury Compensation Program pays approximately one person for vaccination-related injury for every 1 million vaccinations. The estimation of your risk of vaccination-related injury is less than 0.003% of all vaccines given. Contrasting this is the 30%, or almost one-third, of children infected with measles who develop complications like pneumonia, encephalitis, and hearing loss. The numbers favor vaccination by a long margin.

Vaccines are effective. Two doses of the measles vaccine are about 97% protective, and one dose is about 93% effective. For anyone who comes in contact with the measles (while at the Richmond airport, for example), the risk of infection is minimal. The majority of measles cases reported in the U.S. were in unvaccinated children.

Herd immunity is the resistance to spread of an infectious agent within a population when a sufficiently high proportion of individuals are immune to the disease, typically through vaccination. For measles, it is estimated that 95% of the population must be immunized for herd immunity. Virginia’s overall childhood vaccination rate for measles, mumps and rubella (MMR) was estimated at 97.6% in 2017.

However, that was the first year the MMR vaccination rate was above the 95% threshold. From 2004 to 2016, the percentage was in the 80s and 90s. In fact, for all vaccine-preventable diseases, Virginia’s rate is 86.2%. This is concerning and does not allow for adequate risk reduction from vaccine-preventable diseases.

Current vaccine law in Virginia may undermine adequate levels of childhood vaccination, raising the threat of a measles resurgence. Virginia law allows exemptions from vaccination for schoolchildren. Medical reasons exist for those with compromised health. Religious exemptions exist to allow for personal or parental autonomy in making choices for children. Worries are voiced by parents about beef or pork products in the vaccines contradicting religious tenets in Judaism and Islam. Catholics are concerned regarding the virus grown in aborted fetal tissue. However, scholars from these major world religions maintain vaccines as appropriate and necessary to protect the community.

Nevertheless, parents with ongoing safety concerns about vaccines may skirt the legal requirements for public school vaccination by claiming a religious exemption. How many parents use this option is unknown, but one parent from Virginia admitted in a public forum online: “I filed a religious exemption in VA and no one batted an eye or questioned my beliefs. I’m actually an atheist but it’s the only exemption option, aside from medical in VA. Once I was asked by a nurse at the dr.’s office about my religion but just told her that I believe religion is a personal thing and I don’t like to discuss it.”

In the U.S., the 2017-18 median rate of non-medical exemptions was 2%, with individual states ranging from 0.1% to 7.5%, all trending upward from previous years. Non-medical vaccine exemptions in Virginia may decrease immunization rates to below the level required for measles herd immunity.

Many national medical societies call for states to eliminate non-medical vaccination exemptions. Mississippi and West Virginia have never allowed religious exemptions for vaccination. California, New York and Maine eliminated religious vaccination exemptions in the wake of recent outbreaks of measles and whooping cough. California reported a rise in its vaccination rates after eliminating religious exemptions, a major public health feat.

The new Virginia General Assembly should follow suit to eliminate non-medical vaccination exemptions, prior to a major vaccine-preventable illness outbreak in the state. This measure would protect all Virginians from the heartbreak and tragedy of measles and other related diseases.

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Dr. Pamela Bailey is an infectious diseases physician and current epidemiology research fellow in the division of infectious diseases at Virginia Commonwealth University Health System. Contact her at: Pamela.Bailey@vcuhealth.org

Dr. Gonzalo Bearman is an infectious diseases physician, hospital epidemiologist, professor of medicine and the division chair of infectious diseases at the Virginia Commonwealth University Health System. Contact him at: gonzalo.bearman@vcuhealth.org

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