A RISING RED TIDE:  MEASLES

By Mark Magee

Who would believe that the current measles outbreak in Clark County, Washington had its origins in the former Soviet Union?

 

On January 28th, 2019, Washington State health officials declare a state of emergency  as measles cases grow to thirty-six cases and eleven suspected cases.  Feb 5th, 2019.  Seattle KOMO News reports that state epidemiologist Dr. Scott Lindquist identified patient zero as a visitor from outside of the US.  The next day ABC News confirms that the strain of measles found in the Clark County Washington outbreak is the same found in an ongoing outbreak in Eastern Europe. A quick examination of the measles exposure sites in Washington and Oregon show a preponderance of Slavic-identity churches and daycares, along with popular shopping and entertainment sites.  It appears that many of the children and adults initially exposed were members of this community.

 

Laurie Garrett details the rise and fall of vaccination rates in the former Soviet Union in her book The Betrayal of Trust: the Collapse of Global Public Health.  Such was the power of the new Stalinist government that in the late 1920s, the Soviet Union’s version of the national health department demanded that every household delouse to stop the threat of typhoid fever, carried by lice.  Whole households force-marched to delousing centers for treatment; infested homes were burned to the ground. An early Stalinist program, the Sanitary and Epidemiological Services, in addition to spying on physicians looking for deviant and political behavior, gathered up the sick of all sorts and held them until they were either cured or died.  This was the bulldozer-styled Soviet model of a public health action responding to communicable diseases.  A healthy workforce was the fuel of the Soviet economy.   In the 1950s and 60s the public health department enforced mass vaccinations against many diseases, including measles, and it worked.  At the height of the Sanitary and Epidemiological Services power, 280 million people could be immunized in a single month, according to Garrett.  But as the Soviet Union disintegrated in the 1990s, so went public health programs and efforts to control highly communicable diseases. In the information vacuum of a failing empire, some physicians and social critics took up and spread the view that vaccinations created weakness in children by stopping what they considered to be the natural evolution of an immune system in a child. This was the application of that stoic belief that everything that doesn’t kill you makes you stronger, the last refuge of hope in the face hopelessness.  Now, coincident with a resurgence of communicable diseases, disinformation and surged virally throughout the former Soviet Union as well.

 

With this new anti-vaccination belief, along with the disillusioned and dissolved societies’ natural distrust of their recently fallen autocratic and often seemingly arbitrary government practices, Russia and other failed Soviet bloc country citizens turned their back on vaccinations.  With the migration of those same people to the United States, so too came the anti-vaccination beliefs, those beliefs hardened by a failure of a particular immunisation campaign due to improper transportation and storage of an entire lot vaccines.

 

KUOW radio’s David Hyde interviewed Dr. Tetyana Odarich at her clinic in Happy Valley Oregon, a clinic that serves many in the affected community in nearby Clark County Washington. Odarich says that many of her Russian and Ukrainian clients are hesitant to vaccinate their children, and that hesitancy is fueled by Russian-language social media stories.  Several social media news-like stories about injuries from vaccines link to back to Russian internet sites with anti-vaccine messages.

 

But that is not to say that this community is the only one to avoid vaccinations.  Russian and other slavic speakers make up approximately 2% of residents.  Clark County vaccination rates hover around 75%, or more soberingly, approximately 25% of Clark County residents are  unvaccinated. That means that large segments of the community are at risk for the diseases and again. Adding to those dangers, possible carriers of the disease can bring it to people who are unable to receive vaccinations including new born babies, the immunocompromised such as  people on chemotherapy and people with HIV, and the elderly, according to the Vaccine Knowledge Project at Oxford University. Personal choices about vaccines can increase morbidity and mortality, although public health is riddled with friction points where personal choice meets risks to to others.  This conflict comes into sharper focuse

\when projected against the backdrop of a successful global, century-long effort to safeguard populations against avoidable diseases.  The last endemic cases were reported in 2002 in North, South and Central America.

 

Epidemiologist use the term “Herd Immunity” to describe minimum thresholds for disease-resistant societies to avoid an outbreak.  Below this number there are a sufficient number of potential carriers of the disease to infect the remaining unvaccinated and vulnerable people. Measles is highly contagious, according to the CDC, with the virus remains infectious forseveral hours after a person with measles leaves an area if they breath the air or touch it and then touch their eye or nose.  Furthermore, measles will infect 90% of unvaccinated people that come in contact with it.  According to the CDC, “Herd Immunity” for measles is between 90 and 93%, far above the current vaccination rates of Clark County.

 

Introducing active measles into a community with below-herd immunity vaccinations rates will ultimately cause an outbreak, and that is what appeared to happen in Clark County.

 

 

https://www.cdc.gov/measles/contagious-infographic.html

 

https://www.cdc.gov/measles/about/transmission.html

 

http://vk.ovg.ox.ac.uk/herd-immunity

 

https://www.who.int/immunization/sage/meetings/2017/october/2._target_immunity_levels_FUNK.pdf

 

https://www.kuow.org/stories/russian-social-media-fuels-vaccine-anxiety-as-measles-spreads-in-washington-state

 

https://komonews.com/news/local/patient-zero-identified-in-measles-outbreak

 

https://abcnews.go.com/Health/patient-measles-outbreak-foreigner-common-outbreaks-start/story?id=60884130

 

https://www.clark.wa.gov/public-health/measles-investigation

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