Doctors warn measles, rubella cases could be the ‘tip of the iceberg’

Vaccine-preventable diseases can lead to long term health problems and even death. The last death attributed to measles in the U.S. occurred in 2015, according to the CDC. (Mel Stefka/Community Impact Newspaper)
Vaccine-preventable diseases can lead to long term health problems and even death. The last death attributed to measles in the U.S. occurred in 2015, according to the CDC. (Mel Stefka/Community Impact Newspaper)

Vaccine-preventable diseases can lead to long term health problems and even death. The last death attributed to measles in the U.S. occurred in 2015, according to the CDC. (Mel Stefka/Community Impact Newspaper)

Image description
The U.S. Centers for Disease Control and Prevention declared measles eradicated in the U.S. in 2000. Two decades later, cases are again on the rise nationwide. Texas is also seeing a higher number of cases of other vaccine-preventable diseases. (Mel Stefka/Community Impact Newspaper)
Image description
In 2003, the Texas Legislature passed a bill allowing parents to submit nonmedical exemptions for state-mandated vaccinations before enrolling their children in school. In the time since, vaccination rates have dropped, as shown by the following school year data. (Mel Stefka/Community Impact Newspaper)
Recent confirmed cases of previously eradicated, vaccine-preventable diseases have medical leaders in Austin concerned over the city’s vulnerability to potential outbreaks.

On Jan. 16, the Austin Public Health Department confirmed the city’s first case of rubella since 1999. That news came on the heels of the health department clearing Austin’s first measles case in the same time period that was announced in December.

Both of those diseases are preventable by the mumps, measles and rubella vaccine, which is required for Texas children enrolling in school. But nonmedical exemptions from those vaccinations—allowable by state law—have been filed at increasing rates over the past decade in Austin and its surrounding cities.

That leaves Austin vulnerable to an outbreak of even more cases of vaccine-preventable diseases, local health care experts said.

“The measles case and recent rubella case were, luckily, just one person [each.] ... There is no guarantee the next case will be just one person,” said Dr. Elizabeth Knapp, the co-chief of pediatrics at Austin Regional Clinic.


Disease resurgence

On Dec. 21, APH announced it had confirmed the city’s first case of measles in two decades. The infected individual, a man who had traveled abroad, had visited a handful of locations in Austin, including three restaurants and a Target in Northwest Austin, causing the general public to be at risk of contracting the highly contagious disease.

APH was able to close the possibility of an outbreak of measles related to that case. Two weeks later, however, a case of rubella was confirmed in a separate individual.

Last spring, a team of medical researchers predicted these cases may happen in Travis County.

Medical journal “The Lancet Infectious Diseases” in May published a study that found Travis County was one of 25 counties nationwide with the highest risk for a measles outbreak.

“More and more people have been choosing to opt out [of vaccines]. ... Not coincidentally we’re seeing outbreaks of disease,” said Allison Winnike, the president and CEO of the Immunization Partnership, a Texas-based nonprofit that aims to eradicate vaccine-preventable diseases.

Travis and Williamson counties have both seen the rate of students with nonmedical exemptions from immunizations rise since the 2010-11 school year, up to 2.42% and 2.33% in the 2018-19 school year, respectively. The state average in the 2018-19 school year stood at 1.2%.

Private schools, in particular, have the highest nonmedical exemption rates in the area, according to state data.

"We're very lucky it was an individual [measles] case. Our luck is going to run out as these immunization rates continue to drop," said Dr. Renee Higgerson, medical director of inpatient pediatrics and pediatric critical care at St. David's Children's Hospital.

Measles is a highly contagious disease that could, if brought into a small private school community, spread across the entire campus and infect children, said Dr. James S. Hahn, a family medicine practitioner affiliated with health care company MDVIP.

Hahn told Community Impact Newspaper he believes the recent measles and rubella cases in Austin have a high potential to be the first of many.

“It is a possibility that this is the tip of the iceberg,” Hahn stated. “If we see one case, are we waiting on five or 10 cases to appear over the next several months?”

Legal exemptions

Winnike traces the decline in vaccination rates back to 2003 when the 78th Texas Legislature passed a bill allowing exemptions from immunizations for “reasons of conscience.” Previous to that law, students were only allowed exemptions for medical or religious reasons.

In the 2018-19 school year, Austin ISD, Pflugerville ISD and Round Rock ISD hit decade highs in conscientious exemption rates, state data shows.

According to the National Conference of State Legislatures, 45 states and Washington, D.C., grant exemptions from immunizations for religious reasons, and 15 states allow for philosophical exemptions.

California, Maine, Mississippi, New York and West Virginia allow only medical exemptions.

New York changed its state law after a measles outbreak that began Oct. 1, 2018, lasted almost a full calendar year and infected 406 individuals, according to numbers from the New York State Department of Health.

California in 2015 removed exemptions based on personal beliefs after a measles outbreak that began at Disneyland infected 147 people across seven states, Mexico and Canada, according to the U.S. Centers for Disease Control and Prevention.

Several attempts to roll back nonmedical exemptions to vaccines have died in the Texas Legislature. Bills were proposed in 2017 and 2019 that would have mandated every public school campus report exemption rates to the state to be made publicly available. Neither measure made it to a chamber for a vote by lawmakers.

“That [2003] law has been very closely defended by the anti-vaccination lobby that got it passed,” Winnike said. “The anti-vaccination lobby in Texas, although they are small in number, are extremely passionate.”

Global problems

It has been two decades since the CDC declared measles eradicated in the U.S., and a half-century since the measles vaccine was first developed.

Local physicians said the distant memory of the devastating health effects of vaccine-preventable diseases may be part of the reason why vaccination rates have slipped.

“Most parents don’t know people who had polio or measles,” Knapp said. “They have forgotten the one thing we did in the last 50 years that has protected us is vaccination.”

Some measles cases can lead to fatal brain infections later in life, Knapp said.

Pregnant women who contract rubella are at risk for miscarriage, and the developing fetuses are at risk of developing birth defects with lifelong consequences, according to the CDC.

The World Health Organization listed vaccine hesitancy as one of the top 10 threats to global health in 2019, alongside threats such as climate change, ebola and an influenza epidemic. More than 10,000 deaths were attributed to pneumonia and influenza in the Texas 2018-19 flu season.

As immunization rates dip globally, local populations are more at risk of contracting vaccine-preventable diseases, especially as Austin attracts more visitors. More than 45,000 international travelers passed through Austin-Bergstrom International Airport in October, an 18.38% year-over-year increase, according to numbers from the airport.

“We're highly at risk for any infectious diseases because of our global travel. ... You add the high rate of unvaccinated people and that makes a perfect set up [for an outbreak,]" Higgerson said.

It will be more than one year before the next time exemption laws can be addressed at the state level, and Winnike said cities and counties cannot pass their own vaccine policies.

Until then, Knapp said it is important for the local community—including private school institutions, parents and unvaccinated adults—to keep vaccination coverage high to prevent future outbreaks.

The University of Texas at Austin announced this January that beginning in the fall, all incoming students must be vaccinated against measles.

“We want to make sure we are giving safety to those who are too young to receive vaccination or may have an illness that prohibits them from getting vaccinations,” Knapp said.

Note from the editor: A previous version of this story listed the same symptoms for mumps and rubella in the graphics. This mistake has been corrected.
By Iain Oldman
Iain Oldman joined Community Impact Newspaper in 2017 after spending two years in Pittsburgh, Pa., where he covered Pittsburgh City Council. His byline has appeared in PublicSource, WESA-FM and Scranton-Times Tribune. Iain worked as the reporter for Community Impact Newspaper's flagship Round Rock/Pflugerville/Hutto edition and is now working as the editor for the Northwest Austin edition.


MOST RECENT

Voters line up during the Dec. 15 runoff election. (Christopher Neely/Community Impact Newspaper)
Legality of ranked-choice voting prompts disagreement between supporters, city attorneys

If a Jan. 11 petition is validated, Austin voters could decide whether to support the implementation a ranked-choice voting system. But is it unconstitutional?

A group of Austin-area school districts is advocating for early distribution of COVID-19 vaccines for school staff members. (Courtesy Adobe Stock)
Austin-area school districts advocate for teachers to receive COVID-19 vaccines

Educators in the designated population for early distribution of the COVID-19 vaccine in 32 states. Texas was not one of them, according to a Jan. 14 letter signed by 17 Central Texas school districts.

See how COVID-19 is impacting Williamson County. (Community Impact staff)
455 new cases of coronavirus reported in Williamson County on Jan. 14

Keep up to date on how the novel coronavirus has impacted Williamson County.

Dr. Anthony Fauci gave remarks while accepting the Ken Shine Prize in Health Leadership from Dell Medical School. (Screenshot via The University of Texas)
Dr. Anthony Fauci praises UT researcher’s role in vaccine development

Dr. Anthony Fauci's remarks came while accepting the Ken Shine Prize in Health Leadership from Dell Medical School.

Each of the three meetings will focus on a specific element of school operations: one on ongoing coronavirus health and safety updates, one on spring semester learning frameworks and one on the status of district programs in athletics and fine arts. (Community Impact staff)
Round Rock ISD to address COVID-19, spring semester in January town halls

Each of the three meetings will focus on a specific element of school operations: one on ongoing coronavirus health and safety updates, one on spring semester learning frameworks and one on the status of district programs in athletics and fine arts.

Photo of Judge Andy Brown at a press conference
Travis County health leaders say Regional COVID-19 Therapeutic Infusion Center will help unburden hospitals

In its first week, the center offered 120 coronavirus patients an antiviral antibody treatment.

Williamson County broke 25,000 total confirmed COVID-19 cases and added seven deaths Jan. 13. (Courtesy Adobe Stock)
Williamson County breaks 25,000 total confirmed COVID-19 cases, adds 7 deaths Jan. 13

The county is also nearing capacity for hospital and ICU beds for coronavirus patients.

PHoto of a vaccine being administered
Austin Public Health discusses vaccination priorities, registration protocol as regional hub

Local health leaders discouraged people from walking up to vaccine sites without an appointment.

Austin Mayor Steve Adler will still reach his term limit in 2022 if voters approve changes to the election cycle. (Jack Flagler/Community Impact Newspaper)
Potential strong-mayor system in Austin would be 'weakest of any big city in the country,' supporters say

Exactly what kind of a strong-mayor system would Austin have if it was approved by voters? Among the weakest in the country, supporters said.

Texas Comptroller of Public Accounts Glenn Hegar shared a new revenue estimate for the 2022-23 biennium Jan. 11. (Courtesy Texas Comptroller of Public Accounts)
Comptroller projects drop in state revenue, potential for economic uptick for next biennium

Despite the slight reduction in expected revenue for the state's 2022-23 budget, recovery could be on the horizon.

After seeing a 5,000-student decline in enrollment this year, Austin ISD could see its funding cut by the TEA this spring. (Nicholas Cicale/Community Impact Newspaper)
Educators in Austin ask TEA to close funding gaps, allow more flexibility to keep students home

After seeing a 5,000-student decline in enrollment this year, Austin ISD could see its funding cut by the TEA this spring.