David D. Haynes

Milwaukee Journal Sentinel

Measles outbreaks in Washington and New York states have focused new attention on exemptions like the one embedded in Wisconsin law, which allows parents to opt out of immunization "for reasons of health, religion, or personal conviction." Sixteen other states have similar laws, which critics say contribute to a rise in the number of unvaccinated kids.

The latest on this story:

• As of Feb. 21, 159 cases of measles had been reported in 10 states, according to the federal Centers for Disease Control and Prevention. No cases have been reported in Wisconsin.

• A federal health official warned a House subcommittee Wednesday that pockets of low vaccination rates were "a catastrophe waiting to happen."

Dr. Anthony Fauci,director of the National Institute of Allergy and Infectious Diseases, told the committee: "I consider it an irony that you have one of the most contagious viruses known to man juxtaposed against one of the most effective vaccines that we have, and yet … we have not done what could be done — namely, completely eliminate and eradicate this virus."

Which was a striking thing to hear, considering that in 2000, measles was declared eliminated in the U.S.

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Federal attention matters: The House hearing — and one scheduled in the Senate on March 5 — will amplify concern over the measles outbreaks and fuel what already is a very hot debate over exemptions.

How we're faring in Wisconsin: Statewide, 85.7 percent of children had received at least one dose of the vaccine by their second birthday in 2017.

But statewide numbers don't tell the whole story: “It’s really what happens in your local community — that’s what’s important to you," Stephanie Schauer, immunization program coordinator for the state Department of Health Services tells the Ideas Lab.

Immunization rates vary widely across Wisconsin: As one example, in rural Clark County, only 60.7 percent of children had received at least one dose of the measles, mumps, rubella (or MMR) vaccine by their second birthday in 2017, according to DHS records. The reason: The county has a sizable Amish community, and the Amish tend to have very low rates of vaccination. Next door in Wood County, 82.5 percent of kids were vaccinated.

Says Schauer:

"We’re trying to encourage everyone who can be protected to do so. We know that there are individuals in the community, very young infants, people who are immune-compromised who can’t be vaccinated; they are relying on that herd immunity, so it’s important that everyone who can be vaccinated ensure that they are protected."

(Parents can check children's vaccination records online at the Wisconsin Immunization Registry site).

Schauer used the term 'herd immunity.' What's that, and why is measles a special problem? Measles is one of the world's most contagious diseases, spreading easily through the air and lingering for up to two hours after an infected person has left a room. Public health experts say a 95 percent vaccination rate is ideal to prevent the spread of the disease and protect people who are too young to be vaccinated or who have repressed immune systems. That's how "herd immunity" works.

But as the latest outbreaks have shown, there are pockets in the U.S., including in Wisconsin, where immunization rates are well below that gold standard.

Dr. James Conway of the University of Wisconsin tells the Ideas lab:

"You get the wrong person getting off a plane in the wrong place, and it's like dropping a match into a can of gasoline." Conway is director of the Office of Global Health at the UW-Madison School of Medicine and Public Health.

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FDA Commissioner Scott Gottlieb told Axios the federal government might even need to step in:

"It's an avoidable tragedy. Too many states have lax laws."

The World Health Organization says "vaccine hesitancy" — "the reluctance or refusal to vaccinate despite the availability of vaccines" — is one of its top global health concerns in 2019.

What's happening in Washington state: So far, 66 people have been infected, many of them in Clark County (which includes suburbs of Portland, Ore. — an anti-vaccination hot spot). Most of the kids are under the age of 10 and were not immunized. A 2009 article in the New England Journal of Medicine basically predicted the current outbreak in Washington state because so many parents had sought exemptions from vaccination.

Says Conway:

"We've known this. None of this comes as a surprise."

Those opposed to forced vaccination urge caution: Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, which often is labeled as anti-vaccination, told Axios: "(The outbreak) should not be used to justify eliminating the legal right to exercise informed consent to vaccination, which is protected by the inclusion of flexible medical, religious and conscientious-belief vaccine exemptions in public health laws."

Infectious disease experts are keeping a close watch: "There are very few things that can literally float through the air and infect people," says Conway. "That's part of the reason this terrifies us. Once it gets established, it's very hard to shut down." There also are major outbreaks abroad; measles has killed more than 900 people in Madagascar, and Japan is fighting its worst outbreak in a decade.

What the research shows on "personal conviction" exemptions and vaccination:

• States with higher rates of non-medical exemptions have lower measles vaccine coverage, according to a 2018 study led by researchers at Baylor College of Medicine in Houston. That leaves those "hot spots" vulnerable to outbreaks. The study predicted Seattle and Portland, Ore., were prone to an outbreak and reported that Bayfield County in Wisconsin had one of the highest non-medical exemption rates among counties studied.

• Multiple studies have pointed to an increased risk of disease when pockets of unvaccinated people live in the same area, according to a 2009 article in the New England Journal of Medicine. The article cited research connecting whooping cough cases in Michigan with an "exemptions cluster" as well as whooping cough and measles cases in Colorado that were "associated with the frequency of exemptions."

• A 2006 article in the Journal of the American Medical Association concluded, "State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased (whooping cough) incidence." The findings suggest states need "effective administrative controls over granting non-medical exemptions."

• In a 2014 analysis of 42 studies, researchers found that exemption rates were increasing and that most parents were concerned about the safety of vaccines. The study also found that "easier state-level exemption procedures increase exemption rates and both individual and community disease risk."

And finally, there is no link between vaccination and autism: A single 1998 paper published in The Lancet, which made that connection, has been thoroughly debunked; The Lancet eventually retracted the paper. Research has shown repeatedly that vaccination is safe and effective.

Take a deeper dive:

• Check out Devi Shastri's Feb. 4 article on vaccination trends in Wisconsin for USA TODAY NETWORK-Wisconsin.

• Read the CDC's FAQ on measles.

• Traveling abroad? Check out this CDC site.

David D. Haynes is editor of the Ideas Lab. He reports on innovation in business and government and on government transparency. Email: david.haynes@jrn.com. Follow him on Twitter at @DavidDHaynes or Facebook.