Tag: California measles outbreak

Are There 6 Reasons to Oppose SB276?

Not surprisingly, folks are pushing misinformation in trying to get support in their efforts to oppose SB276, the California bill that will help stop doctors from writing fraudulent medical exemptions.

Are There 6 Reasons to Oppose SB276?

It also shouldn’t be a surprise that none of their “reasons” hold water.

There are no good reasons to oppose SB276.
There are no good reasons to oppose SB276.

Are the guidelines for writing medical exemptions too limited under SB276?

If you consider that true medical exemptions to getting vaccinated are not common, then no, they are not.

Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.

What about the high rates of vaccination and low rates of exemptions in California?

Uh, what about the schools in California where 30 to 50% of students have medical exemptions? These clusters of unvaccinated kids with medical exemptions are the concern, not the overall rates of vaccination and exemptions in the state.

And it is only the doctors writing excessive medical exemptions that will trigger an investigation.

What about the Medical Board of California?

While the system that they have in place has allowed them to investigate some doctors, it has mostly failed. While they do have the authority to investigate physicians, for some reason, they can’t get medical records unless a parent cooperates.

“Ms. Simoes provided background on Senate Bill (SB) 277, which passed in 2015, eliminating the personal belief exemption from the requirement that children receive specific vaccinations for certain infectious diseases prior to being admitted to any school or daycare center. She explained that after the passage of SB 277, the Board has had a difficult time investigating complaints related to medical exemptions since an authorization of medical records needs to be signed and many parents or guardians do not want to sign the authorization since it would identify the doctor that provided the medical exemption. She explained that this causes a barrier to investigation since most medical exemption cases cannot be subpoenaed and medical records are needed to conduct an investigation.”

Discussion and Possible Action on SB 276 (Pan) Immunizations: Medical Exemptions

And the Medical Board of California supports SB276.

Who else supports SB276?

In addition to the Governor of California, supporters include the AAP, California Medical Association, California State PTA, Children’s Defense Fund of California, County of Los Angeles, Infectious Disease Association of California, and the March of Dimes.

What to Know About Reasons to Oppose SB276

It should be clear that there is no reason to oppose SB276, unless you don’t want your kids immunized and you want to find a doctor to write them a fake medical exemption.

More on SB276

How Is California’s New Vaccine Law Working?

As clusters of unvaccinated kids in California grew and so did outbreaks of vaccine-preventable diseases, legislators got ahead of the problem with a series of vaccine laws to get kids vaccinated and protected.

  • AB 2109 – signed into law in 2012, and in effect for the 2014-2015 and 2015-2016 school years, it required parents to get a signed form from a health care provider if they wanted to get a vaccine exemption
  • SB 277 – signed into law in 2015, it eliminated non-medical vaccine exemptions and has been in effect since the 2016-2017 school year

So are all of the kids in California vaccinated now?

How Is California’s New Vaccine Law Working?

Unfortunately, some folks have found a way around the new vaccine laws.

How?

Some California doctors have taken advantage of fearful parents, and instead of doing the work to help parents understand that vaccines are safe with few risks, they are writing unjustified medical exemptions.

And since many of these parents share their fears with their friends, these intentionally unvaccinated kids often attend the same schools and use the same doctors to obtain unwarranted exemptions of their own. That results in the pockets of susceptible children we often talk about.

Some of these doctors have even created an industry out of providing medical exemptions to kids to get them out of getting vaccinated and protected before attending school. It is reported that they are selling fake medical vaccine exemptions for conditions that are not true medical contraindications to getting vaccinated!

Bob Sears is having to post about the latest measles outbreaks from the sidelines. There are very few measles cases in California so far this year.
Bob Sears is having to post about the latest measles outbreaks from the sidelines. There have been very few measles cases in California so far this year.

Still, many others have gotten vaccinated.

In fact, after years of declines, the vaccination rates for kids entering kindergarten in 2017 were at the highest rate since at least 1998!

“The proportion of students attending kindergarten in 2017-2018 reported to have received all required vaccines is 95.1%, a 0.4 percentage point decrease (difference of unrounded values) from the 2016-2017 school year and a 4.7 percentage point increase over the three years since 2014-2015. The 2017-2018 rate of 95.1% is the second highest reported for the current set of immunization requirements for kindergarten, which began in the 2001-2002 school year.”

2017-2018 Kindergarten Immunization Assessment – Executive Summary California Department of Public Health, Immunization Branch

What about the exodus from public schools that many predicted?

Orange County was the site of several large measles outbreaks before SB 277 took effect.
Orange County was the site of several large measles outbreaks before SB 277 took effect.

Or the exodus of folks California?

Neither happened.

“About 130,000 more residents left California for other states last year than came here from them, as high costs left many residents without a college degree looking for an exit, according to a Bee review of the latest census estimates.”

More people left California in 2017 than moved here. Who they are and where they went

While some people are leaving, it is typically for economic reasons.

It isn’t because folks have to vaccinate and protect their kids.

So except for not predicting that folks would try to get fake medical exemptions, California’s new vaccine law is working well!

More on the Effectiveness of California’s New Vaccine Law

About Those Vaccine Strains in Measles Outbreaks…

A lot happens to control and contain a measles outbreak these days.

For one thing, you have to confirm that everyone with measles symptoms actually has measles. If you miss anyone, because measles is so contagious, then they could expose other people and the outbreak will keep getting bigger.

How do they confirm who has measles and who doesn’t?

While you could just make a clinical diagnosis, simply relying on the person’s history and pattern of symptoms, typically everyone just gets tested.

About Those Vaccine Strains in Measles Outbreaks…

What kind of testing?

“Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction (RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus.”

Measles For Healthcare Professionals

It depends, but often a throat swab or a throat swab and urine are collected for PCR testing, especially if it has been 7 or fewer days since the patient came down with their rash.

If it has been longer than 7 days, then testing using urine and blood specimens can be performed.

“Molecular analysis can also be conducted to determine the genotype of the measles virus. Genotyping is used to map the transmission pathways of measles viruses. The genetic data can help to link or unlink cases and can suggest a source for imported cases. Genotyping is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.”

Measles For Healthcare Professionals

Because many people get vaccinated during an outbreak and a rash and fever is a side effect of the MMR vaccine, testing becomes very important in those who were recently vaccinated.

Statistics from the 2015 Disneyland measles outbreak...
Statistics from the 2015 Disneyland measles outbreak. Anti-vaccine folks, this slide doesn’t mean what you think it means.

After getting vaccinated, testing helps confirm that someone has vaccine strain measles and not wild type, a vaccine reaction, and don’t actually have measles.

“Here, we describe a real-time reverse transcription-PCR (RT-PCR) method that detects the vaccine genotype (MeVA RT-quantitative PCR [RT-qPCR]) and that can provide rapid discrimination between wild-type-virus infections and vaccine reactions.”

Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

An no, the vaccine reaction is not that they developed measles! They developed a rash and/or fever, a common side effect of the MMR vaccine.

“During outbreaks, measles vaccine is administered to help control the outbreak, and in these situations, vaccine reactions may be mistakenly classified as measles cases.”

CDC on Genetic Analysis of Measles Viruses

So the reports that you might have seen that 31 people in the California measles outbreak had a vaccine strain of measles aren’t true. There were at least 31 people who were recently vaccinated during the outbreak and had a rash and/or fever, and they tested positive for the vaccine strain, proving that they weren’t actually part of the outbreak. None of them actually had measles though.

Has anyone ever gotten the measles after being vaccinated?

“Vaccine‐associated measles is a possible, but extremely rare event.”

Sood et al on Vaccine‐associated measles in an immunocompetent child

Yes, there are a few case reports.

Very rare case reports.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

We know who’s responsible for the rise in measles outbreaks and no, it ain’t folks who have recently been vaccinated. Vaccines are safe and necessary.

Get vaccinated. Stop the outbreaks.

More on Vaccine Strains in Measles Outbreaks

Fake News About Measles Outbreaks?

Many news organizations ran with a story about a multi-state measles outbreak recently.

The CDC tweeted a correction about the multi-state measles outbreak story.
The CDC tweeted a correction about the multi-state measles outbreak story.

They got something wrong though.

There is no ongoing, single, multi-state outbreak of measles this year.

Fake News About Measles Outbreaks?

Is it understandable that some media outlets would have been confused by recent CDC reports?

Not really.

The CDC Measles Cases and Outbreaks page hadn’t been updated since late-July and is still reporting case numbers that are “current as of July 14, 2018,” so there really was no recent CDC report to generate all of this extra attention.

“From January 1 to July 14, 2018, 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia were reported to have measles.”

CDC on Measles Cases and Outbreaks

Although it has been changed to say “107 individual cases of measles have been confirmed in 21 states,” there was nothing to indicate it was a single outbreak that the CDC was monitoring as many sites reported:

Few sites were immune to using a click-bait title to scare folks about the "outbreak."
Few sites were immune to using a click-bait title to scare folks about the “outbreak.”

Unfortunately, many of these reports are still online.

How did it happen?

It’s likely because you have reports from organizations and websites that seem to want to push out content, but don’t have much of a budget to pay health or medical writers to make sure it is accurate.

2018 Measles Cases and Outbreaks

It’s also unfortunate that some of these sites, in trying to correct the idea of a single, nation-wide outbreak, are now trying to minimize this year’s measles outbreaks.

No, there isn’t one large outbreak that is spreading across the United States, but there are a lot of smaller outbreaks, some of which are still ongoing.

And these outbreaks are not something that should still be expected, as we have had a safe and effective measles vaccine for over 50 years and measles was declared eliminated in the United States in 2000!

There is also something very much different about 2018, that not surprisingly, no one is reporting about.

With over 107 cases, things seem very similar to last year right, when we had about 118 cases?

The thing is, in 2017, there was one large outbreak, in Minnesota, with 79 people.

In 2015, at least 139 of 189 cases were from just three large outbreaks, in California (Disneyland), Illinois, and South Dakota.

See what’s different?

This year seems to have more individual cases in more states, each with the potential to grow into one of those big outbreaks.

Why?

You can blame the rise in measles outbreaks in Europe and other parts of the world. And some folks not getting vaccinated and protected and exposing the rest of us when they get sick.

Putting us at risk even though measles is a life-threatening infection, a safe and effective vaccine has been available for 50 years, and every anti-vaccine myth that scares folks has been refuted a thousand times.

That’s the story.

Who’s telling it?

More on Reporting on Measles Outbreaks