Nebraska’s ‘intelligent appreciation’ for vaccine boosts protection as measles makes a comeback

Nebraska’s ‘intelligent appreciation’ for vaccine boosts protection as measles makes a comeback
Four-year-old Broderick Hansen. KENT SIEVERS/THE WORLD-HERALD

Broderick Hansen hopped on the exam table at Children’s Physicians West Village Pointe last week for his kindergarten vaccinations without any fuss.

Among them was a second dose of the vaccine that will protect the 4-year-old from measles, the once nearly gone virus that’s been making a disturbing comeback this year in some parts of the United States, Europe, Asia and Africa.

He cried a bit when the crucial moment came, but quickly calmed when awarded his kindergarten prizes.

Mom Jennifer Hansen said she hasn’t been concerned by news reports of recent outbreaks in the United States because her three children’s vaccinations are up to date. And she plans to keep it that way.

“Although the kiddos don’t like to get shots,” she said, “it’s important to keep them safe.”

That’s exactly the message doctors and public health officials are encouraging us to heed, both locally and at the national level, as concerns rise that hard-won control of the virus may be slipping.

Dr. Melissa St. Germain, vice president of the American Academy of Pediatrics’ Nebraska chapter, said the national organization has stepped up training for doctors in recent years to help them better navigate vaccine hesitancy among patients and families.

Among the scary things about measles, she said, are that it’s extremely contagious and can cause complications, ranging in seriousness from ear infections to inflammation of the brain, in three of 10 who get sick. In rare cases, it can be fatal for small children. And it can be spread days before its telltale rash appears.

Nebraska has not reported any cases of measles this year. The localized outbreaks that have been reported in places such as New York, Michigan and Maryland have been traced to infected travelers who’ve spread the virus in insular communities. An earlier outbreak in Washington that spread to Oregon has been tied to lagging vaccination rates there. As of April 11, 555 cases had been confirmed this year in 20 states, according to the federal Centers for Disease Control and Prevention.

Iowa confirmed two cases last week, both in unvaccinated residents of northwest Iowa. Previously, Iowa’s last case of measles was reported in 2011.

Nebraska has among the nation’s highest vaccination rates. Nationally, the median coverage for the measles, mumps and rubella vaccine among youngsters entering kindergarten in 2017-18 was 94.3 percent. Nebraska came in at 96.2 percent and Iowa at 93 percent.

Dr. Tom Safranek, Nebraska’s state epidemiologist, said that’s a key reason the state has avoided outbreaks so far this year.

“I think the people in Nebraska have an intelligent appreciation for the benefits of vaccinations in general,” he said. While coverage is not a “slam-dunk, 100 percent,” he said, the vaccine hesitancy seen in some other parts of the country has not been as prevalent here.

All states, and Washington, D.C., require vaccines for children who are starting school. All allow for medical exemptions, according to the National Conference of State Legislatures. Nebraska and Iowa also are among the 47 — all but California, Mississippi and West Virginia — that allow for religious exemptions. Neither state, however, is among the 17 that allow for philosophical exemptions.

Nebraska’s opt-out rate on religious grounds was 1.06% in 2017-18, with medical exemptions accounting for an additional .27%. Iowa’s total opt-out rate was 1.18%. Nationally, the number was 2.2%. That nationwide figure marked an increase for the third year in a row, according to the CDC.

Parents do appear to be watching, although they’re not yet overly concerned, several Omaha practitioners said.

St. Germain, who is Broderick’s pediatrician, said the only calls to the West Village Pointe clinic from parents asking whether they should move up their child’s vaccination schedule have come from those within the medical community.

“People are paying attention, and that’s good,” St. Germain said.

Dr. Jason Bruce, a pediatrician and associate medical director for primary care with Boys Town Pediatrics, said clinics have had a few calls from parents checking on their child’s vaccination status.

Both pediatricians said they got more calls in 2015, when three cases of measles were confirmed in Nebraska. One was linked to an outbreak that started at Disneyland in California.

St. Germain said several families who planned travel to the resort that year sought early vaccinations for children under age 1. Children typically get their first measles vaccine between 12 and 15 months and the second between ages 4 and 6. But they can get them earlier.

Bruce said infants six months and older should get a dose if they’re traveling internationally, although it won’t count toward their two doses. He and St. Germain said families may want to talk to their doctors about early vaccination if they know they’ll be traveling to an area where outbreaks have occurred.

A number of people who thought they might have been exposed went to their doctors in 2017 after an ill traveler visited public places in eastern Nebraska, state health officials said. No one who’d been exposed contracted measles that year. However, health officials are working on prevention plans for such situations.

Doctors and other health officials also continue to stress the need to immunize. OneWorld Community Health Centers, for instance, began posting reminders last week on social media.

Said Safranek, “We invest so much in our medical scientific enterprise, and when you come up with a really good solution, it just breaks your heart to see them underutilized.”

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