Measles has been on the rise in the US. This is due, in part, to concerns regarding the safety of the MMR vaccine. Although recent research has provided strong evidence against the association of autism with MMR vaccine administration, some parents still choose to request one or more vaccine exemptions on the basis of personal beliefs for their child to attend day care or school.
So why all the concern over a seemingly inconvenient illness that lasts a week or two? Although the rate of complications is not high in developed countries and the number of cases has significantly dropped since vaccinations were introduced in the 1960s, the disease is highly contagious. While most people who catch measles will only have to deal with cold-like symptoms and a rash, severe complications can occur. In extreme cases, those with measles may experience blindness, ear infections, or respiratory infection - especially for children aged younger than 5 or adults older than 20. Measles can be life threatening, particularly in developing countries.
In light of recent measles outbreaks as well as its general increase in incidence, it is important to consider the vaccination decision fully and carefully. Here are some facts to keep in mind:
In the United States:
- Between January and July of this year, a record number of 131 cases of measles were reported.
- This is more than 3 times the number of measles cases reported for all of 2007.
- Measles cases "imported" from outside the US are at a 12-year low.
- The spike in measles, therefore, has been caused by increased transmission among those not vaccinated.
- Institutional (day care, school) vaccination laws vary among states, but all 50 permit medical exemptions, and most states have nonmedical exemptions as well.
- The number of states permitting philosophical/personal-belief exemptions has been increasing.
There are 3 types of vaccination exemptions available to patients: medical, religious, and philosophical. A medical exemption is granted when a child cannot be immunized without incurring serious health risks (eg, they have a congenital immunological disorder). Religious and philosophical exemptions, on the other hand, are less easily defined. Some states require "proof" of religion in order to receive a nonmedical exemption, whereas others grant exemptions based on "personal conviction," a concept that can be more broadly applied.
A 2006 study in the Journal of the American Medical Association (JAMA) found the following:
- States that allowed "personal belief" as a nonmedical exemption to vaccination had higher exemption rates than states that allowed only religious nonmedical exemptions.
- States with an easy exemption process, such as only a parent's signature, had higher nonmedical rates of exemption than those with more difficult exemption processes (eg, a formal letter from parents, permission from local health department, annual renewal, and/or notarization requirements).
Vaccine Exemptions and Measles Outbreaks:
- In April of 2008, 19 measles cases were reported in Washington state. Sixteen of these cases (84%) were school-aged children who were not vaccinated because of a parent's religious or philosophical belief against vaccination.
- In May of 2008, there were 30 confirmed cases of measles in Illinois. Of these cases, 25 (83%) were school-aged children who were not vaccinated because of parental beliefs.
- Many states lack vaccination requirements for children who are homeschooled, and those states with such requirements may not actively enforce them. As a result, national reportable data for the US is incomplete at best.
- A JAMA study published in 1999 observed that in all states, individuals not vaccinated were 35 times more likely to contract measles than those who received vaccination.
Personal belief exemptions are connected not only with an overall increase in exemptions but also with an increase in measles and pertussis (whooping cough). The greater the number of nonimmunized people in a community, the greater the incidence of measles and pertussis is in unvaccinated individuals. This means that nonmedical exemptions can put the whole community at increased risk, particularly those with medical exemptions. While high rates of vaccination in the US provide a good degree of herd immunity (also known as community immunity), areas with greater numbers of unvaccinated individuals are at risk of continued outbreaks.
Particularly vulnerable community members are:
- Children aged younger than 12 months who have not yet been vaccinated.
- Individuals who cannot be vaccinated because of a medical condition.
In summary, most states allow nonmedical religious exemptions, and many permit them for secular reasons as well. Still, it is important to know that even in children who are otherwise healthy, measles is a highly infectious disease that can cause serious complications. It is vital to understand the facts - the true risks of the vaccine and the potential consequence for yourself, your loved ones, and the greater community - if you are considering an exemption. Being a wise health consumer means evaluating all the facts and making an informed decision based on your needs and medical history.