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By Cody Hooks
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When the United States officially declared the eradication of measles in 2000, it was a major victory for public health.
The disease can cause more than cough, rash or fever that has occurred. Complications can land a person in the hospital with conditions ranging from pneumonia to swelling of the brain. One or two out of every 1,000 people infected with measles will die.
Vaccination against measles is preventable, but the highly contagious disease has made a spectacular resurgence so far in 2019.
Nearly 900 cases were reported in about half of the country. While the state of New York has the highest concentration of measles, Colorado, Arizona, and Texas all have confirmed cases of the disease. New Mexico joined this list last week, when the New Mexico Department of Health confirmed a case of measles in Sierra County.
The spread of measles has caused doctors and health professionals across the United States to worry that their community may be next.
Especially in Taos.
"The fact is we are vulnerable to vaccine-preventable diseases," said Dr. Alana Benjamin, a physician at Taos Whole Health Integrative Care.
The Centers for Disease Control recommends that children receive their first dose of measles vaccine at 15 months of age and their second dose at 4 years of age. But as Taos County proves, this does not happen.
Benjamin notes that, according to his review of public health data, only 43% of children in Taos County aged 18 to 36 months are vaccinated against measles.
This means that more than half of a particularly vulnerable population is without protection against the disease.
"We are ripe for an epidemic," said Benjamin. "It's only a matter of time before it spreads here."
The conversation
In city clinics, conversations about vaccines with parents are common, whether at the public health office or in any of the family medicine practices like Benjamin's office or Schreiber Family Medicine . Doctors have different approaches to conversation, but all bring the conversation back to the importance of vaccines.
Before Benjamin moved to Taos, vaccines were not an important part of his medical practice. Most of the people in these other communities have vaccinated their children on time, she said, so it was not so bad when visiting healthy children.
But since he started practicing in Taos five years ago, the talk about the vaccine seems endless.
"I encounter this problem daily," she said.
It is his approach of listening, while emphasizing the importance of vaccines.
"I am a doctor and I really believe in vaccines, and I think they are one of the most important developments in public health in the country. [the last] century. This is partly why we live as long as we live and why children no longer die as a result of these preventable diseases, "she said.
The CDC recommends that children in 2019 receive more vaccines than in the past – 14 in total, for diseases such as measles, whooping cough, polio and hepatitis. At the same time, the content of vaccinations has improved; mercury is no longer used in childhood vaccines since 2001 and the number of "immunologic components", the weakened form of the disease that creates immunity, has been greatly reduced.
"Having said that, I know a lot of people in this community have different perspectives on this, and I want them to have at least one place where they can at least express their concerns. to gently correct the scientific misinformation, but then establish an open and comfortable environment, "said Benjamin.
Parents tend to worry, she says, about aluminum, which is added to vaccines to make them more effective, or doubling the number of vaccines during regular visits to the doctor. However, the main concern of people who are skeptical about vaccination is autism.
It is at this point that Dr. Lucas Schreiber begins.
"This is a very difficult dilemma that I face on a daily basis.The anti-vaccine movement has become increasingly noisy," Schreiber said. It tells the root of the movement, an infamous but discredited study that "suggests a link between measles, mumps and rubella [MMR] vaccine and autism ".
The author of the study, Dr. Andrew Wakefield, "was eventually found guilty by the General Medical Council of dishonesty and dishonest ethical protocols.Unfortunately, his study (…) has elicited international skepticism about immunization. "
After that, Schreiber uncovers the "real and current danger of diseases that vaccines are designed to prevent".
According to Schreiber, just for measles, "four million children contract measles each year and up to 3000 deaths each year in this country".
"There are real consequences" of not being vaccinated, said Judith Pierce, nurse director of the public health office in Taos, which administers vaccines free of charge to people who do not receive them in a medical office. "We do not want there to be barriers."
But public health campaigns require tactics of many years.
"The most important thing is to build trust," said Benjamin. "Many parents initially did not want to or had not been vaccinated for a while, but over time they trusted me as a doctor and trusted what I said to them, and they came in vaccines. [It’s] because we have developed this relationship ".
Numbers
In early March, as measles epidemics emerged across the country, the Department of Health highlighted a disturbing trend in state immunization rates.
"Over the past seven years, the number of children who are not fully immunized has been steadily increasing in New Mexico.Since 2012 in New Mexico, the number of people dispensed with the recommended vaccinations has increased by 60%. " Lily.
Under the New Mexico law, children can only be vaccinated for two reasons: medical, requiring a medical ticket, and religious. Personal, political or philosophical disagreements with vaccines can not give rise to a formal exemption.
Taos County has always been the county with the highest rate of vaccinated children.
In 2015, 4.6% of children in Taos County aged 4 to 18 years were immunized. Santa Fe County came in second with 3.7%, and Los Alamos County with 2.7%, according to the state's Department of Health.
This ranking has largely remained unchanged, although Taos County now stands at 3.2% and Santa Fe County and Los Alamos County at 2.9% and 2.6%, respectively.
A document published in 2015 on the Ministry of Health website shows that among school districts with more than 600 students, Taos ranks third for the percentage of students benefiting from an exemption – 2 %, compared with 2.1% in Santa Fe and 2.3 to and Alamos counties.
Taos School District Exceptional Program Director Lynn Brashar said the data, although now four years old, is encouraging, as the school district's vaccination rate is higher than that of the county as a whole.
However, although doctors' offices, public health centers and school districts import immunization information into a central, state-run database, it is difficult to obtain a more up-to-date and detailed picture. vaccination rates, especially in schools.
David Morgan, communications manager at the New Mexico Department of Health, said by e-mail that the Ministry of Health did not have vaccination rates by school or district. "I confirmed [the Public Education Department] does not follow immunization exemptions at all, "he said, because the DOH said he was working with the PED" to improve the maintenance of vaccine registers in schools ".
The "best choice" for more detailed data on vaccination rates in schools, he said, "is to contact the different school districts and charter schools".
The news of Taos The first surveys of the Taos Municipal School District on data on vaccines and vaccine exemptions took place in early April.
Lillian Torrez, superintendent of Taos, said Thursday that in the five traditional schools and three charter schools in the district, 50 students were exempted from vaccination.
In the district as a whole, Taos High School has only three exempt students, Taos School has two exempt students, Enos Garcia Elementary School has 10 exempt students and Ranchos Elementary has five students exempt. Among the District Schools, Vista Grande has three exempt students. No specific number of exempt students has been provided by the district or directors of Taos Charter School or Anansi Charter School.
Taos District officials did not report the number of delinquent parents for providing the district with state-prescribed immunization information.
Dangers
Even if a more nuanced vaccination picture is masked, one thing is not: Taos does not have a sufficiently high vaccination rate to protect the most vulnerable people in the community – including very young children who do not have not been vaccinated – against very contagious diseases. .
Some diseases, such as measles, can spread like wildfire in areas with low vaccination rates. If an infected person coughs, for example, the measles germ can stay in the air for hours. It's so contagious that if 10 unvaccinated people come in contact with the germ, up to 9 of them will have measles, according to the CDC.
But vaccines do not only protect an immune person.
If enough people in a community are vaccinated, then the community could benefit from "collective immunity", in which even unvaccinated people, such as babies who are too young or immunocompromised, are somewhat protected from the disease. . Herd immunity works because the germ continues to hit roadblocks – that is, people who are immunized – which means it will not spread as quickly.
But many people need to be vaccinated so that collective immunity can work.
For measles, the immunity of the group comes into effect when about 90 to 95% of the population has received the MMR vaccine. Collective immunity for less contagious diseases still requires a vaccination rate of between 80 and 85%.
"Our vaccination rates do not exceed the threshold required for herd immunity," said Benjamin.
She said that when parents bring their children to her clinic, she is open to the fact that she is vaccinating her children, for their protection and for that of the community.
"Of course, I do not like to inject a needle to my baby, but I think it's necessary for public health," she said.
"I think people think that they are just protecting their children and that they do not necessarily understand that their choice to vaccinate or not to vaccinate actually has a significant impact on the health of the community." , she said. "I'm talking about it, but it's a tough conversation to have with a parent in the exam room without making him feel guilty."
She practices persistence by asking the parents, at each visit, if they are ready to vaccinate their children.
And meanwhile, health professionals are preparing what to do in the event of a local epidemic.
"If we see a local measles outbreak, community doctors will work closely with the New Mexico Department of Health to identify and track the index case and isolate sick or exposed patients," said Schreiber.
Indeed, Pierce, the nurse in charge of the local public health office, said that in the event of an outbreak, her office would take advice from the state epidemiologist to try to to contain the epidemic.
"We would have that support," said Pierce.
"We are ready, as ready as possible," she said.
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