Doctors fear a measles return

    Pediatricians fear it's just a matter of time before a measles outbreak hits Colorado, in part because some parents refuse or neglect to vaccinate their children.

    So far this year, there have been 64 confirmed cases of measles in nine states, according to the U.S. Centers for Disease Control and Prevention. That's the highest number in the same period since 2001.

    In four of the states, including Arizona, the CDC characterized the cases as outbreaks, in which at least three cases are linked by time or place.

    The disease was brought into the U.S. from abroad this year, and health ex- perts are troubled that it spread when it got here. Dr. Bernadette Albanese, medical director of the El Paso County Department of Health and Environment, said that could indicate a weakening of the nation's "herd immunity," in which a population's immunization is so widespread, a disease essentially has nowhere to go.

    Measles is seldom fatal, but it can require hospitalization for a child and lead to serious complications such as pneumonia, ear infections and encephalitis. Symptoms include a high fever, puffy eyes, a runny nose and a rash.

    Vaccinations are credited with dramatically decreasing what were once common and often fatal diseases. Ironically, though, the rarity of such diseases is why some parents don't get their children immunized.

    Doctors say the recent spike in cases illustrates what they've long preached about childhood shots: The diseases haven't gone away, and it's the immunizations that keep them contained.

    "I'm worried about our measles immunization rate," said Dr. Robert Brayden, a pediatrician at the Child Health Clinic at The Children's Hospital in Aurora and head of the Colorado Children's Immunization Coalition. "When our rate falls, we can be virtually guaranteed that we will have measles re-enter our population. It is worldwide, extremely contagious, and it is just a plane ride away."
    The cases this year reflect that. Ten of the patients who contracted the disease got it abroad; the rest appear to have caught it from them.

    Measles has spread at schools, child care centers, hospitals and even a doctor's office waiting room, Albanese said.

    Measles is more contagious than many viruses. It doesn't take a cough in the face or physical contact. Sitting across a room from someone for just a few minutes can be enough to contract the disease.

    "This is really, from a public health standpoint, an alarming issue," said Albanese. "If we don't catch up on immunizations, this is going to continue, and we will see it in Colorado eventually."

    The last case of measles in El Paso County was in 1992, the health department said. The last case in Colorado was in Boulder County in 2006.

    Two El Paso County adults were exposed to the Arizona outbreak, she said, but they were vaccinated and did not contract the disease.

    All but one of the confirmed cases in the U.S. occurred in people who were not immunized or whose status was unknown, the CDC reported.

    Nearly a quarter of Colorado children do not have documented immunizations for measles or other vaccine-preventable diseases, said Brayden. That number is roughly equal to the national average and includes poor families that don't get routine health care.

    But a few parents are simply saying no to vaccines.

    Of the 21 cases of measles in the U.S. this year in people 16 months old to 19 years old - the age group targeted for required vaccinations - two-thirds were exempted for religious or personal beliefs.

    All but two states allow people to opt out of immunization requirements for school on religious grounds; Colorado is one of about 20 states that also allow exemptions on philosophical grounds. Parents can sign "personal belief" exemptions without saying what those beliefs are.

    One study in the Journal of the American Medical Association suggested Colorado's personal-belief exemption was partly to blame for the state's high pertussis rate, one of the worst in the nation.

    Of Colorado's unvaccinated children, Brayden said about 2 percent were exempted for personal beliefs.

    Pediatricians say one recurring concern is parents' fear of serious side effects, chiefly autism.

    "They are almost always poorly informed people who have strong opinions on the subject," said Dr. Fred Cox, who works at one of Memorial Health System's two pediatric urgent care clinics. "I'm very much pro-immunization, and it distresses me greatly when I see people who refuse immunizations. They've generally been misled by some of these crackpot Web sites."

    More than a dozen studies in multiple countries have researched the safety of today's vaccines, especially the measles, mumps and rubella vaccine. Included is research from the Institute of Medicine, a prestigious group of independent scientists whose work is analogous to Consumer Reports for the nonscientific community.

    None of the studies has found links to autism or other serious side effects.

    One study alleging a link between autism and MMR vaccines was later retracted by the journal that published it.

    Dr. Chris Nyquist, a pediatric infectious disease doctor at The Children's Hospital, said people opting out of vaccinations haven't seen the diseases they're meant to prevent and consequently aren't concerned about them.

    "You think the vaccine is worse than the disease," she said, "and that's, unfortunately, a real misconception."

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