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Commentary: We can manage our risk of a measles outbreak

Austin American-Statesman - 5/15/2019

May 15--Measles has returned to the United States with a vengeance, even though it was officially eliminated in 2000. By the end of April, there were 704 measles cases reported in 2019, the most in a single year since 1994, and it's only a matter of time before it hits Austin. There have been 15 cases so far this year in Texas.

It is widely recognized that the resurgence of measles in the U.S. has been enabled by vaccine refusal. However, international air travel is equally important. In prior years, occasional outbreaks have occurred because travelers have brought the virus back with them from measles-prone areas of the world. The risk of international travel, combined with the increasing prevalence of nonmedical exemptions for vaccines, is a recipe for a major public health crisis across the U.S., even in places where vaccination rates are high.

In a risk analysis we conducted, three Texas counties rank among the nation's top 25 counties most at risk for a measles outbreak: Harris, Tarrant and Travis counties, listed in the order of greatest risk.

Harris County is in the Houston metropolitan area, and Tarrant County includes part of Dallas-Fort Worth International Airport. Already, Harris, Tarrant and several counties adjoining them have reported measles cases in 2019. Though Travis County is yet to report a case, neighboring counties Bell and Guadalupe have had cases. We have a high risk of measles in Austin because we get a large number of international travelers and have dense pockets of unvaccinated people in the city.

Schools are our problem communities, and the ones our public health leaders should be keeping a close eye on. Because measles is highly contagious, we need a 95% vaccination rate to achieve herd immunity -- a situation in which it cannot spread. As many as 16 of our schools do not reach that threshold and have vaccine refusal rates higher than 5%.

The worst is Austin Waldorf School, with a 49% vaccine refusal rate for the 2017-2018 academic year, according to data recorded by the Texas Department of State Health Services. Austin Discovery School with 32.1% is next, followed by Kirby Hall School with 27.3%. Austin Montessori School has a 21.9% vaccine refusal rate, and Veritas Academy's is 21.3%.

How should we manage our risk of measles outbreaks? The first and obvious response should be to vaccinate as effectively as possible. We must try to persuade those who refuse vaccines to reconsider, at least for their children's sake and the sake of others who are put at risk because of their vaccine refusal -- most notably children and infants who are the most likely to become seriously ill.

The Centers for Disease Control and Prevention recommends two doses of the MMR vaccine, the first between 12 and 15 months of age and the second between four and six years. However, for international travel, the CDC recommends a first dose of MMR at or after six months. Given the risk of an outbreak, this is an option parents in Austin should seriously consider and discuss with their pediatricians. New York City is already requiring early vaccination for infants in response to the crisis. Austin should follow suit.

The second response should be to minimize contact between unvaccinated individuals and those at risk of infection through no fault of their own. New York provides a precedent by temporarily banning unvaccinated individuals from public places in outbreak areas.

Should measles cases begin to appear in Austin, such drastic temporary measures should be on the table. In such a circumstance, we should at least limit attendance in high-risk schools to vaccinated children and adults, as well as limit access to libraries, parks and social events such as concerts.

Sarkar is a professor of philosophy and integrative biology at the University of Texas and an expert on public health.

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