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Measles Outbreaks and Vaccinations: Does it Change Anything?

VaccinesIn most communities in the United States today, the measles vaccination rate is a relatively high 94 percent. But some areas fall short of that average for various reasons: lack of awareness, lack of access, and a growing vaccine refusal movement. With one of the lowest vaccination rates, Pennsylvania currently hovers around 87 percent; Colorado and Arkansas are at 86 percent.  Coverage can be even lower at the county level, particularly in Oregon and Washington.

So, in the aftermath of the Disneyland outbreak – which eventually sickened 147 people across seven states – does all the heightened awareness around vaccines change attitudes? Could these events ultimately impact vaccination rates?  

While it’s too soon to tell if we’ll see an uptick or decline in rates, research suggests that past outbreaks have done little to move the needle, said Alison Buttenheim, PhD, MBA, an assistant professor of Nursing at Penn’s School of Nursing.

“While I would be delighted to be proven wrong, I think there are…reasons why we won’t see a lasting impact of the outbreak on exemption or refusal rates,” Buttenheim recently wrote in a post featured on Penn’s Leonard David Institute of Health Economics blog. A vaccine refusal researcher who focuses mainly on California, she couldn’t find any evidence that the highly-publicized 2008 outbreak in San Diego had an impact.

“Our attention spans are limited. And the media moves on eventually,” she said.

People are also often set in their ways, and more education about vaccines and media coverage isn’t likely to sway parents, unless perhaps they have a child who is approaching the vaccination age and are truly on the fence, Buttenheim said. The so-called anti-vaxxers tend to stay in their corner, and the pro-vaccinators do the same, many researchers agree.

“It’s very hard to change minds that are already made up,” Buttenheim said. “If you believe that vaccines are unsafe or unnecessary, more evidence to the contrary is not going to change those beliefs – in fact, it might do the opposite.”

Indeed, a recent study in Pediatrics from Jessica Fishman, PhD, from the departments of Psychiatry and Biostatistics and Epidemiology, and Ian Frank, MD, a professor in the division of Infectious Diseases at the Perelman School of Medicine, and colleagues found that parents with more knowledge about vaccinations and infectious diseases (in that case, it was HPV) were not more likely to vaccinate their children.

There are differences with this outbreak, however, that the public health community has taken notice of.

We’re dealing with very high numbers. There were more than 600 measles cases  in 2014, when the U.S. experienced 23 outbreaks, reports the Centers for Disease Control and Prevention. Since January 1, 2015, there has been a total of 159 confirmed cases through April 3, most of which are related to the Disneyland outbreak.Multi-state-outbreaks

We’ve haven’t seen such numbers in almost 20 years, according to the CDC, which is, of course, taking it very seriously. In February, Tom Frieden, director of the CDC, went on CBS’ Face the Nation to express his concern over a potential larger outbreak because of the growing number of people who are not vaccinated. To compare, there were fewer than 50 cases in 2012.

With that, the media coverage becomes more widespread. And Disneyland makes a great headline. 

The relatively newer, far-reaching tentacles of social media are a factor not to be ignored either.

Our social media feeds were, and in some cases still are, populated with vaccine arguments, from celebrity voices to infographics that help explain the role of herd immunity.  It’s been an avalanche of stories, gaining momentum with every share, retweet, post, blog, etc. that follows.  We’re buried underneath it all for a lot longer than we were even three or four years ago.

What’s more, many doctors took to social media when the Disneyland story broke in early January. They shared thousands of articles and links throughout February and their tweets, with the exception of two days during that month, even outpaced those of the media, a report from MDigitalLife found. Much of those tweets revolved around “false balance” complaints, because many journalists were giving equal weight to the anti-vaccine argument, which gives the impression that there is truth to many of the claims that science has debunked. 

“It’s not known whom and what social media influences with respect to vaccinations, but it’s certainly something that researchers are interested in investigating further,” Buttenheim said.

One thing to note is the type of information we are drawn to.  “We tend to look for, screen for, pay attention to, and believe tweets or other information that confirms (rather than challenges) our pre-existing beliefs,” she added.

Think about it: many people follow friends, organizations, and outlets that fall in line with their beliefs. So is social media really showing us another perspective? An old headline from Wired magazine perhaps says it all: “The web's 'echo chamber' leaves us none the wiser.”

Still, in the age of hashtags (click on #vaccines or #measles and you’re going to get everything—from the  doctors, media, activists, celebrities, etc.) and “here’s my side of the story” comments on posts and stories, we’re still getting some dose of whatever side we don’t agree with.

Now, whether this encourages or discourages parents to get their children vaccinated remains to be seen.

“The outbreak has certainly generated some conversation among my colleagues and with some patients,” said Stephen Gluckman, MD, an infectious disease doctor at Penn Medicine. “As you might imagine, the discussion has been overwhelming negative about parents who do not vaccinate their children.”

Children should be vaccinated, he said, and not vaccinating yourself or your children puts the rest of society at high risk.   

Whether vaccination rates have gone up or down will be revealed when CDC surveillance data for 2015 comes out next year. Though it didn’t address rates, a recent survey did point to an early sign of a potential, positive shift. 

A small HealthDay News/Harris Poll of 2,000 adults published last month found that more Americans now say they have positive feelings toward vaccinations. The poll found that 87 percent of those surveyed said vaccines are safe—which is up from 77 percent from a similar poll last year.

"I think the measles outbreak is causing some people to re-examine their 'facts' about childhood vaccinations," Aaron Glatt, MD, a spokesman for the Infectious Diseases Society of America, told HealthDay last month. "Unfortunately, sometimes it takes a scare."

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