Missouri has the lowest rate of measles, mumps and rubella (MMR) vaccination in all 50 states. Of all children 19 to 35 months of age, only 85.8% have received at least the first round of the MMR vaccine according to a 2017 CDC National Immunization Survey. The CDC Childhood Vaccination Schedule states that children are supposed to receive the first dose of MMR vaccine at 1 year of age and a second dose between 4 and 6 years of age.
The U.S. was declared to have eliminated measles by the Pan American Health Organization in 2000. Since then, outbreaks of measles have occurred throughout the U.S., but all cases have been traced to travelers who entered the country with the infection.
As of the end of April, 2019, the Centers for Disease Control and Prevention has confirmed at least 704 cases of measles in the U.S. This is the largest number of cases since 1994. Unless the spread of measles can be stopped, the U.S. may be stripped of the elimination status this year.
“As more cases are being reported, it is becoming increasingly difficult to track the original source of the outbreak,” said René Najera, an epidemiologist and editor of the vaccine education website The History of Vaccines, in the NPR article Is Measles Here to Stay? This means people in the U.S. are in danger of spreading this highly infectious disease through local populations.
Ten cases have been confirmed in Missouri since the end of April. It is speculated that the source was an international traveler who resides in the state, according to the Missouri Department of Health and Senior Services. Although ten cases do not appear to be anything to worry about, this could be only the beginning.
“The measles virus can be active in a room for up to four hours after the infected person has left the room,” said Dr. Susan Even, director of MU Student Health and American College Health Association liaison to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. “[For example] if someone was found to be infected with measles, but had gone to Starbucks around 9 a.m. that morning, a public health announcement would be sent out to notify all people at the Starbucks location from 9 a.m. to 1 p.m. that they may have been exposed to measles and need to seek medical attention.”
Measles is contagious from four days before a rash appears to four days after the appearance of the rash according to the CDC. This means infected persons can spread the disease without knowing they are ill because the virus spreads through saliva particles expelled through coughing and sneezing.
Children under the age of 1 year, immunocompromised individuals, those allergic to the MMR vaccination, and other unvaccinated persons are most at risk for contracting the disease. In order to protect those who cannot get the vaccination, all other persons need to become vaccinated.
Some individuals do not see why immunizations are necessary as many of the diseases children are vaccinated against are no longer prevalent in the U.S. This view usually leads to two different paths when it comes time for these individuals to vaccinate their own children. One path is an alternate immunization schedule. The other is to seek a waiver to allow for that child to go unvaccinated. An alternate immunization schedule can translate into a variety of different vaccination plans.
“Some parents choose to not vaccinate their child for polio, because it is not seen in the United States anymore, but they will ask for the Tdap vaccine because pertussis – whooping cough – is actively present in the U.S.,” said Trina Teacutter RN, nursing supervisor at the Boone County Health Department. “Those seeking a [non-vaccination] waiver have to provide religious or medical evidence to get one in the state of Missouri.”
With the last round of outbreaks cropping up in major cities in the U.S., a few cities and states are increasing their influence on parents’ right to choose the vaccination plan for their children. In Brooklyn, New York, the Department of Health has issued a public safety order that requires all parents in a few Jewish Orthodox communities to vaccinate all children with the MMR vaccine. The order came after having to close the fourth school due to a measles outbreak.
The state of Washington passed a bill recently that will remove “philosophical or personal objection” from the list of reasons to legally not receive the MMR vaccine. The bill will appear In the State House of Representatives soon after the Senate amends a passage in the bill.
For now, the University of Missouri community can refrain from worrying about a measles outbreak on campus. According to Dr. Evan, less than 1% of the student population is not confirmed to have received the MMR vaccine. This means that Mizzou exceeds the recommended rate of 95% herd immunity to effectively deter a measles outbreak.