CLEVELAND, Ohio – Measles, a virulent disease that killed hundreds of Americans in the days before vaccines, is sickening people in five regions across the country.

Could a similar measles outbreak happen here?

“It is absolutely possible,” said infectious disease specialist Dr. Robert Frenck with the Ohio Chapter of the American Academy of Pediatrics. He is a professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

Measles vaccination rates are on a downward slide statewide. Facebook posts spread misleading information about vaccines. Parents who have never seen a measles rash wonder why they should worry about something their kid probably won’t get.

All this leads health officials to wonder if the state could be headed for another outbreak like the one in 2014, which resulted in more than 300 cases in Amish communities outside Columbus.

It happened because unvaccinated Amish missionaries brought the disease back from overseas, Frenck said. With more families opting not to vaccinate their children – and almost any point on the globe only a plane ride away – the next measles outbreak might not be confined to isolated communities.

Measles is a highly contagious disease that can lead to serious complications such as pneumonia and encephalitis, or swelling of the brain. The Centers for Disease Control and Prevention is tracking five outbreaks across the country, in Washington state, New York City, two in New York state and Texas.

The virus can’t spread in locations where vaccination rates are high.

Ohio’s measles vaccination rate stood at 88 percent in 2017. That’s well above the 80 percent needed for herd immunity, Frenck said. Herd immunity means that unvaccinated people are protected because most people around them are vaccinated. Parents who choose not to vaccinate their children count on herd immunity to keep them from contracting communicable diseases.

“These parents see perceived risk (of vaccines) without the perceived benefits,” Frenck said. “This is based on misinformation.” Research has shown no link between vaccines and Sudden Infant Death Syndrome (SIDS) or autism spectrum disorder, according to the CDC.

Frenck doesn’t want Ohio’s vaccination rate to drop any further.

“Once it starts to slip, it’s hard to turn around,” he said. “I don’t want to see a child die because of a misunderstanding about vaccines.”

No longer a childhood disease

The first infectious disease that humans eradicated was smallpox. Polio is close to becoming the second. Third on the target list is measles.

This very contagious disease is caused by a virus that spreads through the air when an infected person coughs or sneezes. It causes fever, runny nose, red eyes and a distinctive rash of tiny red spots all over the body. Ear infections and diarrhea are common complications.

The virus can replicate in the lungs, heart or brain, making it especially dangerous. It is the leading cause of blindness in developing countries, according to the World Health Organization. For every 1,000 children who get measles worldwide, one or two will die from it, and one or two will suffer permanent brain damage.

Before the measles vaccine became widely available in 1963, measles was a common childhood disease that sickened 3 to 4 million Americans and killed 400 to 500 people each year.

Now, receiving an MMR – measles, mumps and rubella (German measles) – shot has replaced these illnesses as a rite of childhood. Most children receive their first MMR dose before they are 15 months old, and the second shot prior to age 6 years.

The number of cases has steadily declined. There have been very few cases of measles in Ohio since 2012, with the exception of the 2014 outbreak.

Ohio law mandates that children receive their vaccinations to attend public school, but allows exemptions for certain medical conditions, or religious and philosophical objections. In many area school districts, parents fill out a waiver form stating their objection to immunization. If there is an outbreak of measles or mumps at the school, unvaccinated children are required to stay home.

In the Cleveland Heights-University Heights City School District, 23 elementary students out of 2,205 requested a vaccine exemption this school year.

In the Parma schools, 18 out of 652 first grade students have opted out. Akron city schools granted an exemption to 18 of the 9,629 elementary students.

Five out of 1,163 elementary students in the Kent City School District are unvaccinated this year. Even that low number worries Rita Baker, district nurse for the Kent City School District. She has seen the number of unvaccinated children rise over the past few years.

“It’s really scary to think we have people who aren’t immunized and opt out,” Baker said.

If parents are worried about side effects from the measles vaccine, Baker points out the vaccine’s benefits. “We need to get better information out to people,” she said.

Why parents opt out

Vaccination rates may be dropping because parents of children who had a reaction or injury due to vaccines are likely to decline additional shots, Stephanie Stock, president of Ohio Advocates for Medical Freedom (OAMF), said in a email.

Ohio Advocates for Medical Freedom is a nonprofit, non-partisan group advocating for the right to decline any medical procedures or medications. That includes vaccinations, which come with risks, Stock said.

Stock pointed to existence of the Vaccine Adverse Event Reporting System (VAERS), a national program that monitors vaccine safety, as evidence that vaccines aren’t safe. VAERS collects and reviews reports of health problems or side effects occurring after a vaccination and determine if further investigation is needed, the CDC says on its website.

Stock also cited the National Childhood Vaccine Injury Act of 1986, and its clause shielding vaccine manufacturers from civil suits for some vaccine-related injury or death, as additional evidence against vaccines.

The act also says vaccine manufacturers can be held liable in cases of fraud, intentional withholding of information or lack of due care. It sets up a National Vaccine Injury Compensation Program and National Vaccine Injury Compensation Trust Fund, and grants U.S. district courts authority to determine eligibility and compensation in case of vaccine-related injury or death.

“OAMF will always support a parent’s right to decline vaccinations for their children,” Stock said. “Vaccinations have risks, so there must be choice.”

Historically, vaccination rates rise in response to media reports of measles outbreak, said infectious disease specialist Frenck. News reports about illness in Washington state may lead to more children being vaccinated.

But the bump only lasts for one to two years.

“It is sad if it takes an outbreak to remind parents the importance of vaccination because that means it took children becoming ill (and at risk of dying) from a preventable disease before parents made the decision to immunize their child,” he said in a follow-up email.

“The benefits of vaccines far outweigh the risks,” Frenck said.