Measles still a threat locally as cases rise globally, pediatricians say

Routine childhood vaccinations improving, but still not back to pre-pandemic levels.

Credit: AP

Credit: AP

The number of measles cases and deaths related increased worldwide in 2022 over 2021, according to the most recent data from the World Health Organization.

>> Since this story first published, Montgomery County recorded its first confirmed measles case in nearly 20 years.

With the risk of global cases spilling over to the U.S., experts say there is still more work to be done to increase routine childhood vaccinations and prevent future outbreaks.

“The pandemic had the effect of lowering access to health care in general around the world, and since 2022, we’ve seen a little bit of improvement, but certainly we’re not anywhere near the pre-pandemic level that was still subpar in a lot of areas of the world, so we still … have a lot of work to do,” said Dr. Sara Guerrero-Duby of Dayton Children’s Pediatrics.

Compared to 2021, measles cases increased by 18% and deaths increased by 43% globally in 2022. This takes the estimated number of measles cases to 9 million and deaths to 136,000 — mostly among children, according to the World Health Organization and the Centers for Disease Control and Prevention.

“Measles cases anywhere pose a risk to all countries and communities where people are undervaccinated. Urgent, targeted efforts are critical to prevent measles disease and deaths,” said John Vertefeuille, director of CDC’s Global Immunization Division.

Measles globally creates risk for unvaccinated kids

In 2022, 37 countries experienced large or disruptive outbreaks compared with 22 countries in 2021, the CDC said. Of the countries experiencing outbreaks, 28 were in the World Health Organization’s region for Africa, six in the Eastern Mediterranean, two in Southeast Asia and one in the European Region.

The fear doctors have is of travelers and visitors from around the globe who can bring measles into the local region, affecting those not yet fully vaccinated or whose families are choosing not to vaccinate, Guerrero-Duby said.

“The world is so very small, and everyone travels. People travel to other countries, and they certainly can travel back to United States,” Guerrero-Duby said.

The region saw the impact of this recently with the measle outbreak in 2022 originating in the Columbus area and eventually touching Clark County, bringing the first measles case to that county in more than two decades.

Misinformation on social media

The Clark County Combined Health District is seeing more families decline getting their children vaccinated and signing a waiver instead, said Health Commissioner Charlie Patterson. He would like to see more families consult a doctor, first, though, he said, adding this has been an effect from both the pandemic and misinformation spread on social media.

“It’s a post-COVID effect, but it’s the combination of COVID and social media,” Patterson said.

Vaccination data from the schools showed hesitation and decreased numbers of children with all of their required immunizations happening prior to the pandemic, as well, including around 2016-2017, he said.

“I still hear people talk about, well, they don’t want their kids vaccinated because it causes autism. More and more scientific proof, study after study that says the initial study was flawed, it has no effect. It just so happens that when kids are getting vaccines, especially like the second MMR, is in that range of about 4 years of age when the first signs of autism shows up in many of these children,” Patterson said.

Montgomery County health officials have seen the impact of misinformation being spread online and on social media. The region saw more people turning to Google and social media for medical advice, spreading misinformation, which propagated quickly, said Dr. Becky Thomas, medical director at Public Health - Dayton and Montgomery County.

“The consumer of social media has to be extremely careful about what they’re looking at, the validity of the information, the source of the information, the credibility of the information,” said Dan Suffoletto, public information manager for Public Health.

Public Health is using its own social media accounts to share accurate information and understandable ways and accurate tools families need to make informed decisions for their children.

Shifting opinions on vaccines

Public Health officials said parental opinions on vaccines shifts during the pandemic as parents became more skeptical of vaccines.

“There was increased distrust in vaccines and increased hesitancy as new information came out,” Thomas said. “We had new types of vaccines that were perhaps not easy to understand and not well explained at first, and that created some uncertainty in the benefits and how they would outweigh the potential risks of the vaccine, and that sort of that perceived increase in concern about vaccine safety spilled over into other routine vaccines that kids get before they go to school.”

Public schools with the lowest percentage of kindergarten students with all required immunizations by county, 2022-2023 school year
CountySchool with lowest percentagePercentage of students with all required immunizationsPercentage of students up to date on MMR vaccine
ButlerFairfield Central Elementary School (Fairfield)56.44%60.40%
ChampaignUrbana Elementary School (Urbana)92.02%94.48%
ClarkSnyder Park Elementary School (Springfield)79.49%84.62%
DarkeVersailles Elementary School (Versailles)74.73%80.22%
GreeneMills Lawn Elementary School (Yellow Springs)75.00%81.25%
MiamiCookson Elementary School (Troy)73.21%85.71%
MontgomeryDixie Elementary School (New Lebanon)31.94%33.33%
PrebleTri-County North Elementary School (Lewisburg)80.60%82.09%
ShelbyLongfellow Primary School (Sidney)65.60%65.60%
Warren Pennyroyal Elementary School (Franklin)65.22%82.61%

Access to health care and places that provide childhood vaccinations, transportation and time to get to those appointments, and knowledge of where to find vaccines, such as vaccines that qualify for the Vaccines for Kids program, are all barriers that can prevent families from getting their children vaccinated on schedule, Public Health said.

Shutdowns during the pandemic also affected vulnerable communities.

“During the early months of the pandemic when there was a shutdown...children who lived below the poverty level and those living in rural areas did have lower rates of vaccinations, so some disparities did emerge during that time,” Thomas said.

Approximately 95% of kids need to be vaccinated with the two doses of the MMR vaccination to protect against measles outbreaks. The county in this region that got the closest to this threshold among its kindergarten students in the 2022-2023 school year was Champaign County with 94% of its kindergarten students having all of their required vaccinations, according to the Ohio Department of Health. Warren County was second highest at 91.6%.

Shelby County had the lowest percentage of kindergartners with all required vaccinations with 77.3%, according to ODH, followed by Montgomery County at 85.3% and Clark County at 86.7%. Butler County reported 87.6% of its kindergartners with all required doses for the 2022-2023 school year, ODH said.

Ohio kindergarten county level reporting, 2022-2023 school year, per ODH
CountyPercentage of students with all required dosesPercentage of students with a medical exemptionPercentage of students with a reason of conscience or religious objectionIncomplete
Warren 91.6%0.4%4.6%3.4%

Routine vaccinations still relevant

Parents need to feel these vaccines are relevant in today’s world, Thomas said, and not just something their grandparents dealt with in their childhoods.

“Measles, for example, killed about 6,000 children a year before vaccines became available in the 1960s, and we know that measles is still around globally and in the United States today, and when we have pockets of unvaccinated individuals, then we see outbreaks like we saw in Columbus last year of measles and other infections that are preventable by vaccines,” Thomas said.

There’s no “risk-free” vaccine, but the risk of a negative reaction to a vaccine outweighs the risk of catching diseases like measles. Sore arm from the injection or redness where the shot is given, fever and a mild rash can happen after MMR vaccination, according to the CDC, which says more serious reactions are rare.

“There’s not a zero-risk vaccine out there, but my kids got all their vaccines because I looked at the risk of what happens when you get measles, mumps, rubella, chicken pox, whooping cough … I looked at the effects of that versus the slight risk that’s involved in the vaccinations, and I decided that it was worth the risk,” Patterson said.

Health experts encouraged parents to consult with a trusted physician or health provider when deciding if vaccinations are right for their kids.

“I think it’s important for parents to recognize that they really are their child’s best advocate and it’s important to establish a relationship with a health care provider that they trust so that they can have their specific concerns addressed,” Thomas said.

A break down of the 2022-2023 Central Ohio measles outbreak

During the 2022-2023 measles outbreak in central Ohio, 85 locally acquired measles cases were confirmed with rash onsets during Oct. 22 through Dec. 24, 2022, according to the Centers for Disease Control. The outbreak was declared over on Feb. 4, 2023, 42 days ― the length of two measles incubation periods ― after the last reported case.

By the numbers:

  • The first two cases were reported Nov. 5, 2022, among two unvaccinated 2-year-old children.
  • During June 12 through Oct. 8, 2022, four internationally imported measles cases had been confirmed among unvaccinated Franklin County residents who had traveled to areas in East Africa, though no definitive link was established between these cases and the central Ohio outbreak.
  • The 85 confirmed cases included 78 in Franklin County, two in Madison County, and one each in Clark, Fairfield, Richland, Ross and Union counties, all counties within central Ohio.
  • The patients ranged in age between 6 months and 15 years, and the median age was 1 year old.
  • Of the 85 cases, 80 were unvaccinated, though 60 were age-eligible for a routine measles, mumps, and rubella (MMR) vaccination. The vaccination status of one patient was unknown.
  • There were 44 patients who experienced complications, 36 were hospitalized, and there were no deaths reported.
  • Reported exposure locations for measles included five health care facilities accounting for 32 of the 85 cases, four child care facilities with 22 cases, and households with 17 cases.
  • Columbus Public Health and Franklin County Public Health departments identified 739 local contacts who were unvaccinated or had unknown vaccination status and required quarantine.

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