National

After having practically eradicated measles from the U.S. almost two decades ago, a growing anti-vaccination movement has led to a resurgence of cases, currently focused in the Pacific Northwest and New York.

Why it matters: Unless doctors and the public step up to counteract the vocal opposition to vaccines with evidence-based facts, there is a serious concern that infectious diseases like measles could return full force, public health officials and scientists tell Axios.

Driving the news: Washington state Gov. Jay Inslee declared a state of emergency Jan. 25 after multi-county cases caused a "public disaster." There were 36 cases reported on Monday.

The nearby city of Portland, Oregon, is also concerned, as there have been dozens of possible exposure locations, ranging from a Portland Trail Blazers game to a children's museum.

In 2018, there were 349 cases reported in 26 states and D.C., including outbreaks in New York and New Jersey where many were unvaccinated people in Orthodox Jewish communities.

Several of these outbreaks (defined as 3 or more cases) are continuing into 2019, including in NYC and Rockland County, New York.

Public health officials are concerned the pro-vaccination message isn't getting through, they tell Axios.

"When we see outbreaks of measles like this one, it’s a reminder to parents that many diseases rarely seen in the United States can affect their unvaccinated children. In some cases, children with measles may go on to develop serious complications, like pneumonia.” 

Nancy Messonnier, director, CDC's National Center for Immunization and Respiratory Diseases

"There's incorrect information about the safety of the MMR vaccine and its association with autism, which is 100% false. ... This is one of the most highly contagious diseases out there, but it's balanced against one of the most effective vaccines out there, [which is] 97% effective."

Anthony Fauci, director, National Institute of Allergy and Infectious Diseases

Between the lines: Some of the main factors behind the anti-vaxxer movement are disbelief that measles is such a bad disease, anti-government sentiment, a misguided sense that the vaccine can be harmful, and lack of accessibility.

"This is a very dangerous situation, and I don't think people fully appreciate how difficult and dangerous it is," Fauci says.

Pre-vaccine, measles was the cause of deafness, encephalitis or death for some children. People have forgotten how they "were clamoring" for a vaccine, he adds. 

"Anti-vaccinism often goes hand in hand with suspicion of experts, government and Big Pharma and with conspiracy theories and skepticism about science generally," Helen Bedford, children's health professor at the University College London, tells Axios.

Part of this is due to fear the vaccine causes autism. This fear spiked when a small 1998 study linked the measles vaccine and autism (a study later found fraudulent and retracted), Fauci says. 

For instance, Ukraine's current large outbreak (already 8,500 in 2019) is mainly due to unsubstantiated fears over safety, Bedford says.

"[Anti-vaxxers'] voice is loud and they have powerful influencers such as celebrities who attract media coverage. Messages can also spread in seconds around the world via social media (perhaps even faster than measles can spread!)," Bedford says.

"Overall, it is factors such as difficulties accessing services that play an important role in under-immunization, as a result of large families, poverty [and] social disadvantage," Bedford adds.

What's next: Fauci says evidence-based science must be consistently promoted by clinicians and public health officials. Bedford agrees, "Science has demonstrated repeatedly that vaccines are highly effective and very safe. We don’t say this loudly or frequently enough!"

Global disease risk worsening as anti-vaccination campaigns spread (Axios Expert Voices)

Measles cases spiked 30% worldwide in 2017, WHO says (Axios)

Italy's anti-vaccine push could spread around the world (Axios)

"This is a very dangerous situation": Experts sound alarm on measles

Washington state had to declare a public emergency.

Illustration of a man yelling with vaccination syringes projecting from his mouth. 

Science

Anti-vaccination movement

Health Care

After having <a class="gtmContentClick" data-vars-link-text="practically eradicated measles" data-vars-click-url="https://www.cdc.gov/measles/about/history.html" data-vars-content-id="c5186795-abd9-481b-b24c-ac05e4545fad" data-vars-headline="&quot;This is a very dangerous situation&quot;: Experts sound alarm on measles" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/measles/about/history.html" target="_blank">practically eradicated measles</a> from the U.S. almost two decades ago, a growing anti-vaccination movement has led to a resurgence of cases, currently focused in the Pacific Northwest and New York.Why it matters: Unless doctors and the public step up to counteract the vocal opposition to vaccines with evidence-based facts, there is a serious concern that infectious diseases like measles could return full force, public health officials and scientists tell Axios.

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Health

Columbus

Axios Columbus

The country's largest measles outbreak is happening in Central Ohio — with no signs of slowing down.

Of the 117 nationwide cases reported as of Dec. 22, 70% were in Franklin County. 

Why it matters: Until this outbreak, our area hadn't confirmed a measles case in 20 years.

The highly contagious respiratory disease was declared eliminated in the U.S. in 2000, but dipping vaccine rates during the pandemic have revived it among unvaccinated pockets.

Threat level: The CDC and WHO said last month that measles is "an imminent threat in every region of the world," Axios' Jacob Knuston reports.

Symptoms include a high fever, cough, runny nose and watery eyes, with a signature rash appearing three to five days later. 

Serious complications such as pneumonia and encephalitis are possible.

By the numbers: Of the 82 local cases confirmed as of Thursday, none were fully vaccinated and 39% were hospitalized. 

28% are under 1 year old, meaning they're too young to be vaccinated and were relying on herd immunity for protection.

State of play: Measles likely arrived in Columbus after four unvaccinated travelers separately went to measles-endemic countries from June to October, Columbus Public Health commissioner Mysheika Roberts tells Axios.

The CDC was here for the two weeks after Thanksgiving and is offering support.

Of note: The two-dose measles vaccine is 97% effective.

The challenge is reaching the small number of Central Ohioans spreading the virus by not vaccinating their children. 

What they're saying: "It's very frustrating, knowing that it's preventable with a vaccine — a safe, effective, accessible vaccine," Roberts says. 

The health department is ready to administer shots, but only half a dozen parents have brought kids in since the outbreak started this fall.

What we're watching: Measles is easily spread in public places and symptoms can develop up to 21 days after exposure.

An outbreak isn't declared over until 42 days after the last infected person develops a rash — meaning it could be months before this is considered under control locally.

This story has been updated to reflect the most recent case numbers. 

With 82 cases, Central Ohio measles outbreak leads U.S.

Until this outbreak, our area hadn't confirmed a measles case in 20 years.

Illustration of a syringe and glass medicine bottle with a post-it note attached that says "to do"

Measles

The country&#x27;s largest measles outbreak is happening in Central Ohio — with no signs of slowing down.<ul><li>Of the 117 <a class="gtmContentClick" data-vars-link-text="nationwide cases" data-vars-click-url="https://www.cdc.gov/measles/cases-outbreaks.html" data-vars-content-id="b922be96-d4a7-4b04-ac33-5f8bc17cf3f7" data-vars-headline="With 82 cases, Central Ohio measles outbreak leads U.S." data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/measles/cases-outbreaks.html" target="_blank">nationwide cases</a> reported as of Dec. 22, 70% <a class="gtmContentClick" data-vars-link-text="were in Franklin County" data-vars-click-url="https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport?publish=yes" data-vars-content-id="b922be96-d4a7-4b04-ac33-5f8bc17cf3f7" data-vars-headline="With 82 cases, Central Ohio measles outbreak leads U.S." data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport?publish=yes" target="_blank">were in Franklin County</a>. </li></ul>

News

New York says it has reached a "milestone" in halting the measles outbreak that started in October 2018, and U.S. public health officials now believe the country has retained its measles elimination status — just barely meeting the year deadline, a spokesperson for the Centers for Disease Control and Prevention said Thursday. 

Yes, but: Recent cases reported from returning international travelers demonstrate the danger of new outbreaks when there are still pockets of communities with low vaccination rates. Despite measles being mostly preventable, the combination of the anti-vaccination movement and vaccine hesitancy places several communities at risk.

The latest: New York's health commissioner announced Thursday morning that "there are no longer any active cases in New York State associated with the initial measles outbreak from October 2018."

But the commissioner added that New York health officials remain "vigilant" and are currently investigating several other new cases that are unrelated to the outbreak that just ended. 

1 of the new cases is a person who just returned from overseas to Rockland County, which had declared in September that its initial outbreak had officially ended. Because this new case was "imported" from someone traveling in another country, this is not considered to be part of the same outbreak.

Several other New York cases were reported in Nassau (2), Monroe (2) and Putnam (1) counties, according to the health commissioner.

Meanwhile, the CDC says 31 states reported 1,243 individual patients, 131 of whom were hospitalized and 65 of whom suffered complications, including pneumonia and encephalitis. No one died in the U.S.

"The end of the New York state measles outbreak is a credit to the great work by local and state health departments, community and religious leaders, and other partners. However, this outbreak is a grave reminder that we need heightened vigilance around measles as well as other vaccine preventable diseases, and we continue to address the myths and misinformation driving these outbreaks."

What they're saying: Peter Hotez, professor of pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine, tells Axios that America's measles elimination status isn't as important as "the fact that we remain highly vulnerable" for 2 reasons.

There are "at least 100 geographic pockets in the U.S. where a high percentage of kids are not being vaccinated, together with measles cases now regularly imported from Europe where measles is even more widespread," Hotez says.

During the first and second quarter of next year, "we’ll again hit peak measles transmission season. [The] bottom line [is] nothing has really been done to combat the anti-vaccine movement in America, and we’re just as vulnerable to measles epidemics as we were this time last year."

What's next: The CDC and the Department of Health and Human Services are expected to have further information on the measles outbreak on Friday.

The Pan American Health Organization’s regional verification commission will meet in the coming months to look over the U.S. data from this year and likely 2018 to make the final determination on the U.S.' elimination status, the CDC spokesperson said.

PAHO declared recently that the U.K., Albania, the Czech Republic and Greece had lost their measles-free status.

Anti-vax movement targets Maine law on vaccine exemptions

New measles cases decline in U.S., but the outbreak isn't over yet

Measles in U.S. creeps back toward endemic status

U.S. likely to retain measles elimination status — but barely

Recent cases reported from returning international travelers demonstrate the danger of new outbreaks.

Collage of an arm receiving a vaccination shot over an American flag, with measles dots scattered throughout

Public health

New York says it has reached a &quot;milestone&quot; in halting the measles outbreak that started in October 2018, and U.S. public health officials now believe the country has retained its measles elimination status — just barely meeting the year deadline, a spokesperson for the Centers for Disease Control and Prevention said Thursday. Yes, but: Recent cases reported from returning international travelers demonstrate the danger of new outbreaks when there are still pockets of communities with low vaccination rates. Despite measles being mostly preventable, the combination of the <a class="gtmContentClick" data-vars-link-text="anti-vaccination movement" data-vars-click-url="https://www.axios.com/report-million-dollar-donations-fund-anti-vaccination-movement-65ca36cf-99f4-4084-9258-67573d15b15d.html" data-vars-content-id="e97ed162-0fd8-4d95-822c-e24aee340a1e" data-vars-headline="U.S. likely to retain measles elimination status — but barely" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/report-million-dollar-donations-fund-anti-vaccination-movement-65ca36cf-99f4-4084-9258-67573d15b15d.html" target="_self">anti-vaccination movement</a> and <a class="gtmContentClick" data-vars-link-text="vaccine hesitancy" data-vars-click-url="https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/" data-vars-content-id="e97ed162-0fd8-4d95-822c-e24aee340a1e" data-vars-headline="U.S. likely to retain measles elimination status — but barely" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/" target="_blank">vaccine hesitancy</a> places several communities at risk.

The federal government may try to take action if states don't tighten their vaccine exemption laws and measles continues to spread in sections of the U.S., FDA Commissioner Scott Gottlieb tells Axios. 

Driving the news: Overall case numbers of measles remain low in the U.S. but the disease is growing in areas of high non-vaccination rates. Some states like Washington are considering tightening their exemptions even as they continue to face a more organized anti-vaccination movement.

"It's an avoidable tragedy," Gottlieb, who says he's usually a proponent of state rights, tells Axios. "Too many states have lax laws."

Background: The highly contagious disease can only be controlled if there's a large vaccination rate in the population, which the World Health Organization says should be 93%–95% of people.

States are allowed to adopt their own rules over what types of exemptions are allowed for vaccines. All of them allow exemptions for medical reasons, but many also provide exemptions on religious and/or philosophical grounds.

These pockets of unvaccinated people are transmitting measles in the U.S., which is particularly dangerous to those who can't get vaccinated, including babies under 12 months and people with susceptible immune systems.

Gottlieb says the vaccine is one of the most effective ones (97% with 2 doses) created so far, and for one of the most contagious viruses.

Measles can cause various complications, including pneumonia, brain damage and sometimes death, and it has been linked to longer term immune problems. 

WHO reported last week that measles cases tripled globally in 2018 from the prior year, and current reports show multiple deadly outbreaks in the Philippines, Ukraine, Israel and Madagascar.

In Washington state, the number of confirmed cases has more than doubled since Gov. Jay Inslee declared a state of emergency on Jan. 25, to 54 as of Feb. 13. 

Clark County, where a majority of the Washington cases are located, reported a 70% MMR vaccination rate for 19–35 month olds. But since the outbreak, there was an almost 450% increase in vaccination rates in January compared with the same month the prior year.

In New York, there is an outbreak in Rockland County,  Monroe County and New York City, and Texas reported 8 cases in 5 different counties as of Feb. 14. 

"It's a self-inflicted wound," says Peter Hotez, dean at Baylor College of Medicine who published a study last year showing possible U.S. "hotspots" of measles due to vaccine exemptions, that he says is already proving to be true.

Pro-vaccination groups are "losing the battle" to anti-vaccination groups, who've been very active on social media and forming at least one PAC to promote their message, he says.

The other side: Barbara Loe Fisher, co-founder and president of the nonprofit National Vaccine Information Center often labeled as anti-vaccination, tells Axios that 100 cases of measles in a population of 320 million "is not a public health emergency." 

"[It] should not be used to justify eliminating the legal right to exercise informed consent to vaccination, which is protected by the inclusion of flexible medical, religious and conscientious-belief vaccine exemptions in public health laws," she says.

Measles cases spiked 30% worldwide in 2017, WHO says

Italy's anti-vaccine push could spread around the world

Measles outbreak is bringing vaccine exemptions into spotlight

FDA Commissioner Scott Gottlieb told Axios: "Too many states have lax laws."

Illustration of school children standing in a room with one red, contagious student

Politics

The federal government may try to take action if states don&#x27;t tighten their vaccine exemption laws and measles continues to spread in sections of the U.S., FDA Commissioner Scott Gottlieb tells Axios. Driving the news: Overall case numbers of measles remain low in the U.S. but the disease is growing in areas of high non-vaccination rates. Some states like Washington are considering <a class="gtmContentClick" data-vars-link-text="tightening their exemptions" data-vars-click-url="https://www.tvw.org/watch/?eventID=2019021154" data-vars-content-id="f4e67b60-5b19-4a9c-9454-b702739d56a0" data-vars-headline="Measles outbreak is bringing vaccine exemptions into spotlight" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.tvw.org/watch/?eventID=2019021154" target="_blank">tightening their exemptions</a> even as they continue to face a <a class="gtmContentClick" data-vars-link-text="more organized" data-vars-click-url="https://finance.yahoo.com/news/amid-measles-outbreak-hundreds-rally-preserve-right-not-vaccinate-children-211532643.html" data-vars-content-id="f4e67b60-5b19-4a9c-9454-b702739d56a0" data-vars-headline="Measles outbreak is bringing vaccine exemptions into spotlight" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://finance.yahoo.com/news/amid-measles-outbreak-hundreds-rally-preserve-right-not-vaccinate-children-211532643.html" target="_blank">more organized</a> anti-vaccination movement.

While it's still too soon to say Central Ohio's measles outbreak is over, the virus's spread significantly slowed in January.

The latest: The most recently reported local case, the 85th of this outbreak, developed a rash on Dec. 24. 

What's happening: Columbus Public Health (CPH) officials believe greater awareness of the outbreak and a surge in MMR (measles, mumps and rubella) vaccinations could be contributing to the decline, a spokesperson tells Axios. 

The health department administered 200 MMR shots last month, nearly double the rate of December clinics in recent years.

What's next: To officially end an outbreak, two virus incubation periods, or 42 days, must pass after the last infected person developed a rash.

That would make early February the earliest CPH could declare our local outbreak over — if no other cases are reported.

Flashback: Ohio's last measles outbreak, among the Amish community northeast of Columbus, lasted four months and infected 383 people in 2014.

Central Ohio's measles outbreak improving, not over

Officials believe a surge in MMR vaccinations could be contributing to the decline.

Illustration of a round bandaid in the shape of smiley face on a child's arm

While it&#x27;s still too soon to say Central Ohio&#x27;s <a class="gtmContentClick" data-vars-link-text="measles outbreak" data-vars-click-url="https://www.axios.com/local/columbus/2022/12/20/central-ohios-measles-outbreak-leads-nation" data-vars-content-id="26b1da6e-cb91-4682-9f03-11363aeedba4" data-vars-headline="Central Ohio&#x27;s measles outbreak improving, not over" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/local/columbus/2022/12/20/central-ohios-measles-outbreak-leads-nation" target="_self">measles outbreak</a> is over, the virus&#x27;s spread significantly slowed in January.The latest: The most recently reported <a class="gtmContentClick" data-vars-link-text="local case" data-vars-click-url="https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport?publish=yes" data-vars-content-id="26b1da6e-cb91-4682-9f03-11363aeedba4" data-vars-headline="Central Ohio&#x27;s measles outbreak improving, not over" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport?publish=yes" target="_blank">local case</a>, the 85th of this outbreak, developed a rash on Dec. 24.