A dose of the mumps, measles and rubella vaccine is indicated. (Photo: Milwaukee Journal Sentinel)

Epidemics of measles in The states of Washington and New York have paid new attention to exemptions such as the one incorporated into the Wisconsin law, which allows parents to not be vaccinated "for reasons of health, religion or personal belief ". Sixteen other states have similar laws, which critics say would help increase the number of unvaccinated children.

The latest news from this story:

As of 21 February, 159 measles cases 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 on Wednesday warned a House subcommittee that low vaccination rates were an "imminent disaster".

Dr. Anthony Fauci,Director of the National Institute of Allergy and Infectious Diseases, told the commission: "I find it ironic that you have one of the most contagious viruses that we know that has been juxtaposed to one of the most effective vaccines we have, and yet … we have not done what could be done – namely, completely eliminate and eradicate this virus. "

What was striking to hear was that in 2000, measles had been declared eliminated in the United States.

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The attention of the federal government counts: The House hearing, including one in the Senate on March 5, will magnify concerns over measles outbreaks and fuel an already heated debate on exemptions.

How we are doing in Wisconsin: At the state level, 85.7% of children had received at least one dose of the vaccine before their second birthday in 2017.

But the figures at the state level do not tell the whole story: "It's really what's happening in your community – that's what's important to you," says Stephanie Schauer, immunization program coordinator for the state's health services department at the Ideas Lab.

Vaccination rates vary considerably in Wisconsin: For example, in rural Clark County, only 60.7% of children received at least one dose of measles, mumps, rubella (or MMR) vaccine before their second birthday in 2017 , according to the records of the DHS. The reason: the county has a large Amish community and the Amish tend to have very low vaccination rates. Next to Wood County, 82.5% of children were vaccinated.

Schauer says:

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"We are trying to encourage all who can be protected to do so, we know that there are individuals in the community, very young infants, immunocompromised people who can not be vaccinated, they are counting on the immunity of their flock It is therefore important that all people who can be vaccinated ensure that they are protected. "

(Parents can view child immunization records online at the Wisconsin Vaccination Registry site).

Schauer used the term "herd immunity". What is it and why is measles a particular problem? Measles is one of the most contagious diseases in the world. It spreads easily through the air and persists until two hours after the departure of an infected person. Public health experts estimate that a 95% vaccination rate is ideal for preventing the spread of the disease and protecting people who are too young to be vaccinated or who have a suppressed immune system. This is how "herd immunity" works.

But, as recent outbreaks have shown, there are pockets in the United States, including Wisconsin, where vaccination rates are well below this gold standard.

Dr. James Conway from the University of Wisconsin explains at Ideas Lab:

"You get the wrong person coming down from a plane in the wrong place, and it's like if you light a match in a gas can." Conway is Director of the Global Health Office at the UW-Madison School of Medicine and Public Health.

[Join the Ideas Lab group on Facebook, where we discuss ideas to solve problems in Wisconsin].

FDA Commissioner Scott Gottlieb told Axios that the federal government may even need to intervene:

"It's a preventable tragedy – too many states have lax laws."

According to the World Health Organization, "hesitancy about vaccines" – "reluctance or refusal to vaccinate despite availability of vaccines" – is one of its main concerns when it comes to Global Health in 2019.

What is happening in the state of Washington? Up to now, 66 people have been infected, many in Clark County (which includes the suburbs of Portland, Oregon.) A hot spot for anti-vaccination. Most children are under 10 years old and have not been immunized. A 2009 article in the New England Journal of Medicine predicts essentially the current outbreak in Washington State because many parents have asked to be exempted from the vaccination.

Conway says:

"We have experienced this – none of this is a surprise."

Opponents of forced vaccination call for caution: Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, often referred to as an anti-vaccination, told Axios: "(The epidemic) should not be used to justify the removal of the legal right to exercise informed consent to vaccination, which is protected by the inclusion of flexible exemptions for medical, religious and belief vaccines in public health legislation. "

The experts in infectious diseases closely monitor: "There are very few things that can literally float in the air and infect people," Conway said. "That's partly why it terrifies us, once it's established, it's very difficult to close it." There are also major epidemics abroad; Measles has killed more than 900 people in Madagascar and Japan is fighting the worst epidemic in the last decade.

What research shows about exemptions from "personal beliefs" and immunization:

• According to a study conducted in 2018 by researchers at Baylor College of Medicine in Houston, states benefiting from a higher number of non-medical exemptions benefit from lower measles immunization coverage. This leaves these "hot spots" vulnerable to epidemics. The study predicted that Seattle and Portland, Oregon, would be prone to an outbreak and indicated that Bayfield County, Wisconsin, had one of the highest rates of non-medical exemption. among the counties studied.

• According to a 2009 article in the New England Journal of Medicine, many studies have shown an increased risk of disease when pockets of unvaccinated people live in the same area. The article cites research linking the cases of whooping cough in Michigan and a "group of exemptions", as well as cases of whooping cough and measles in Colorado, "associated with the frequency of d & # 39; 39; exemptions ".

• An article published in the 2006 journal of the American Medical Association concluded: "State policies granting exemptions from personal beliefs and stating that easy exemptions are easily associated with an increase in the incidence (of whooping cough)". The results suggest that states need "effective administrative controls to grant non-medical exemptions".

• In 2014, in an analysis of 42 studies, researchers found that exemption rates increased and that most parents were concerned about the safety of vaccines. The study also revealed that "simpler exemption procedures at the state level increase exemption rates and the risk of individual and community illness".

And finally, there is no link between vaccination and autism: Only one article published in 1998 in The Lancet, which established this link, has been completely debunked; The Lancet finally retracted the paper. Research has repeatedly shown that vaccination is safe and effective.

Take a deeper dive:

• See Devi Shastri's February 4 article on Wisconsin vaccination trends for USA TODAY NETWORK-Wisconsin.

• Read the CDC's Measles FAQ.

• Traveling abroad? Check out this CDC site.

David D. Haynes is editor of the Ideas Lab. It reports on innovation in business and government and government transparency. Email: [email protected] Follow him on Twitter at @DavidDHaynes or Facebook.

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