By Karen Dandurantnews@seacoastonline.com
PORTSMOUTH — While some states are seeing outbreaks of measles, prompting the federal government to look at state vaccination exemption rules, it has not been seen on the Seacoast.
Dr. David Itkin, infectious disease specialist at Portsmouth Regional Hospital, said each state sets its own exemptions for who may opt out of the measles vaccine and while the federal government has not yet made the decision to intervene, he feels it may be a discussion worth having.
“Measles is perhaps the most effectively spread of our respiratory viruses,” said Itkin. “In a susceptible group, 90 percent will catch it. It’s incredibly contagious. I think the leniency of allowing a philosophical exemption has enabled this disease to reemerge, where it was once gone.”
Dr. Benjamin Chan, New Hampshire's state epidemiologist, said measles was declared eradicated in the United States in 2000, but not abroad. He agrees the reemergence calls for discussion among the heath care community.
“There is no federal law defining the exemptions that are allowed,” said Itkin. “It’s also true that while there may be side effects, receiving the vaccine is still more responsible. The big concern we still hear is the risk of autism and that has been completely debunked.”
In New Hampshire, there are two allowed exemptions for not receiving the vaccine. Dr. Chan said medical and religious exemptions can allow a parent or guardian to choose not to vaccinate.
The states involved in the outbreaks have a third exemption. It is called a philosophical exemption and allows any parent to simply choose not to vaccinate.
Maine has all three exemptions. Emily Spencer, a spokesperson for Maine’s Department of Health and Human Services’ Division of Disease Surveillance, said the last measles case they saw was in 2017, and prior to that, in 1997.
Chan said no measles cases have been seen in New Hampshire now or within the last five years.
“It is important to note that we have been occasionally notified of cases that involve travelers,” said Chan. “They may have been in an area where measles is currently infectious. They did not lead to outbreaks.”
Jackie Dockham, Director of Infection Prevention at Exeter Hospital, said the last case she saw was 30 years ago.
“A woman came into the hospital for a different reason,” said Dockham. “She had a rash, and no one knew exactly what it was. Dr. Itkin came in and looked and said she had measles. The woman had not been on infection precautions and it caused quite a stir at the hospital. We make it mandatory now to know a patient’s status. Most of our staff are immunized, but once we had an employee who was a non-responder to the vaccine. That can happen with hepatitis B, too.”
Itkin said he has not seen an outbreak here but was part of overseeing one in the late '80s, in Omaha.
“It was pretty scary,” said Itkin. “Where you see low rates of vaccination tend to be in certain geographical areas. There are political/socio groups that include a higher rate of anti-vaxxers. They have state laws that enable them to opt out simply because they do not believe in the vaccination. They don’t trust the FDA (Food and Drug Administration) or the pharmaceutical companies that make the vaccines. They think natural immunity is better and they do not want the government telling them they have to do this.”
Chan said New Hampshire has a very high vaccination rate, with most children receiving the vaccination prior to entering school. The state tracks vaccination rates and in 2017-2018, the percentage of vaccinated children was 98 percent.
“That means we only had about 2 percent of children unvaccinated,” said Chan. “Of those, 52 percent were religious exemptions.”
“We do not have the philosophical exemption here,” said Chan. “For the medical exemption, a notarized document from the child’s physician is required. The religious exemption is a little less clear but also requires a notarized document.”
Because measles is a live attenuated vaccine, a child who has had a severe allergic or anaphylactic reaction to the first of two shots can be medically excused. Those who are immunosuppressed can opt out and pregnant women should not receive the vaccine.
Itkin added some people can be allergic to neomycin, an antibiotic used in the production of the vaccine.
“That’s all the more reason to have the people around them vaccinated, to offer the best protection,” said Chan. “Infants up to 12 months cannot receive the vaccination and the same principal of those close to the child getting vaccinated is advised. It’s called cocooning and means just what it sounds like, surrounding the infant with protected people.”
Chan said measles is one of the most infectious viral diseases. It is airborne and proximity is all that is needed to contract it.
Dockham said a newborn is immune-naked and the best way to protect them is to immunize everyone who will be in contact with the child, as is done with pertussis.
“As parents, we buy the best and safest crib,” said Dockham. “We research every safety measure. Why would you not offer this protection? It is a very safe vaccine. I know of some doctors who will not be your provider if you refuse vaccinations.”
“If one child gets it, nine or ten people near them who are not immune can get it,” said Chan. “Each of them can spread it to another nine or ten, and soon there is an outbreak.”
The higher the rate of vaccination, the less risk there is of measles spreading because of the herd immunity. Vaccinated people are the best way to stop the spread of the disease.
Measles begins with high fever, a cough and runny nose. A rash develops, moving from head to toe. There is no specific treatment, only supportive care for the symptoms and for complications.
“Some people get over measles on their own but there is a significant risk of complications and some can be severe,” said Chan. “One in 20 cases develop into pneumonia. More rarely there is encephalitis, swelling on the brain. There can be death.”
Itkin said choosing not to get the vaccination is more than a passive act. He said it is choosing to risk having your child exposed to a potentially dangerous disease.
“It is important to stress that measles is highly infectious and can cause serious, even life-threatening illness and the best protection is to get the vaccination,” said Chan. “It’s the best protection for the child, and for those around them. Two doses are 99 percent effective.”
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