Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak

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Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak
3:41

May 3, 20174:24 PM ET
Heard on All Things Considered
MARK ZDECHLIK

FROM

measles-1-aef5227c033697dfbab80ad4f78ac41fd3daed3a-s800-c85.jpg


Khadra Abdulle, a resident of St. Paul, stops to shop at the Riverside Market in the Cedar-Riverside neighborhood of Minneapolis. It's the inaccurate information about a link between vaccines and autism, she says, that's keeping some well-meaning parents from getting their kids vaccinated against measles.

Mark Zdechlik/MPR
Health officials in Minnesota have been scrambling to contain a measles outbreak that has sickened primarily Somali-American children in the state. So far health officials have identified 34 cases, still mostly in Hennepin County, and they're worried there will be more.

In Minnesota, the vast majority of kids under two get vaccinated against measles. But state health officials say most Somali-American 2-year-olds have not had the vaccine — about six out of ten. As the outbreak spreads, that statistic worries health officials, including Michael Osterholm, who directs the University of Minnesota's Center for Infectious Disease Research and Policy.


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"It is a highly concentrated number of unvaccinated people," he says. "It is a potential kind of gas-and-match situation."

Measles is a highly contagious respiratory disease that causes a rash and fever. It can be deadly, but the Centers for Disease Control and Prevention says two doses of vaccination are about 97 percent effective in heading off the disease.

The Minnesota Department of Health says the outbreak began in Hennepin County, home to Minneapolis and the heart of the nation's Somali-American community.

Somali-American leaders here are in firm agreement with the Minnesota health department in trying to knock down the pseudoscience behind the unfounded claims that getting vaccinated can lead to autism. But anti-vaccine groups have been quick to fan fears, even as the outbreak spreads.

A social and commercial hub of the community is the Cedar-Riverside neighborhood, adjacent to downtown Minneapolis. Inside a building called the Riverside mall, more than a dozen stalls are tightly clustered, open-air style.


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She's quick to name the fear that's working against the measles vaccine among Somali-Americans.

"They believe it causes autism."

A weekend meeting in Minneapolis, organized by anti-vaccine groups (the Vaccine Safety Council of Minnesota, the Minnesota Natural Health Coalition, the National Health Freedom Action and Minnesota Vaccine Freedom Coalition and The Organic Consumers Association) attracted dozens of Somali-Americans. Some members of the audience shouted down physicians — including pediatrician Dr. Stacene Maroushek — who showed up to try to convince them vaccination is crucial.

"We know If there's less than a certain rate of vaccination, the virus is much more likely to spread," she told the gathering. "That's a scientific fact."

Kris Ehresmann, the infectious disease division director at the Minnesota Department of Health, describes the Minnesota measles outbreak as a "public health nightmare" — a lot of unvaccinated people, living in densely populated neighborhoods and a tremendously contagious disease.

Ehresmann says she's beyond frustrated with the dis-information campaign by anti-vaccine advocates, who have been working against efforts to contain the outbreak.

"I'll be honest. It makes me very angry," she says.

But Ehresmann says the desire to get the truth out is mobilizing public health officials.

"We've had people on Somali TV, Somali radio. We've participated in chat rooms. The commissioner met with imams to talk to them about how we can work with the faith community to do outreach," she says.

In 2000, U.S. public health officials declared that measles had been eliminated in the U.S., thanks to a strong vaccination program. That means measles is no longer native to the U.S., but as vaccination rates have eroded in some areas, it can spread quickly if a sick traveler brings it in.

In 2014, there were 667 cases in the U.S., including a large outbreak among Amish communities in Ohio. In 2015, there were 188 cases, including some linked to an outbreak that started at the Disneyland amusement park. Prior vaccination is critical to keeping people from contracting the virus if they are exposed to it.

Almost 30 years ago measles sickened 460 people in Minnesota and three children died in that outbreak. Osterholm served as the state epidemiologist at the time, and says those deaths still haunt him. He's worried it could happen again.

"I think we could surely see a major increase in the number of cases beyond what we have now," he says. "With that comes the increasing likelihood someone will die."
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Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak


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Anti-vaccine activists spark a state’s worst measles outbreak in decades






By Lena H. Sun May 5 at 7:00 AM
largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter, who had a rash, high fever and a cough, was hospitalized for four nights and needed intravenous fluids and oxygen.

“I thought: ‘I’m in America. I thought I’m in a safe place and my kids will never get sick in that disease,’ ” said Salah, 26, who has lived in Minnesota for more than a decade. Growing up in Somalia, she’d had measles as a child. A sister died of the disease at age 3.

Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organized by anti-vaccine groups. The advocates repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents.

Immunization rates plummeted and, last month, the first cases of measles appeared. Soon, there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities.

“It’s remarkable to come in and talk to a population that’s vulnerable and marginalized and who doesn’t necessarily have the capacity for advocacy for themselves, and to take advantage of that,” said Siman Nuurali, a Somali American clinician who coordinates the care of medically complex patients at Children’s Hospitals and Clinics of Minnesota. “It’s abhorrent.”

Although extensive research has disproved any relationship between vaccines and autism, the fear has become entrenched in the community. “I don’t know if we will be able to dig out on our own,” Nuurali said.

Anti-vaccine advocates defend their position and their role, saying they merely provided information to parents.

“The Somalis had decided themselves that they were particularly concerned,” Wakefield said last week. “I was responding to that.”

He maintained that he bears no fault for what is now happening within the community: “I don’t feel responsible at all.”

How measles outbreaks happen in the U.S.

Play Video1:01

This video from the Centers for Disease Control and Prevention explains how measles spreads and how to prevent it. (Centers for Disease Control and Prevention)
MMR vaccination rates among U.S.-born children of Somali descent used to be higher than among other children in Minnesota. But the rates plummeted from 92 percent in 2004 to 42 percent in 2014, state health department data shows, well below the 92-94 percent threshold needed to protect a community against measles.

Wakefield, a British activist who now lives in Texas, visited Minneapolis at least three times in 2010 and 2011 to meet privately with Somali parents of autistic children, according to local anti-vaccine advocates. Wakefield’s prominence stems from a 1998 study he authored, which claimed to show a link between the vaccine and autism. The study was later identified as fraudulent and was retracted by the medical journal that published it, and his medical license was revoked.

The current outbreak was identified in early April. As of Thursday, there were 41 cases, all but two occurring in people who were not vaccinated, and all but one in children 10 and younger. Nearly all have been from the Somali American community in Hennepin County. A fourth of the patients have been hospitalized. Because of the dangerously low vaccination rates and the disease’s extreme infectiousness, more cases are expected in the weeks ahead.

Measles, which remains endemic in many parts of the world, was eliminated in the United States at the start of this century. It reappeared several years ago as more people — many wealthier, more educated and white — began refusing to vaccinate their children or delaying those shots.




The ramifications already have been significant. A 2014-2015 measles outbreakinfected 147 people in seven states and spread to Mexico and Canada. In California, high school students were sent home because of infected classmates. One patient who was unknowingly infectious visited a hospital and exposed dozens of pregnant women and babies, including those in the neonatal intensive care unit. Another adult patient was hospitalized and on a breathing machine for three weeks.

Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. The combination is 97 percent effective in preventing the viral disease, which can cause pneumonia, brain swelling, deafness and, in rare instances, death.

Minnesota’s Somali community is the largest in the country. The roots of the outbreak there date to 2008, when parents raised concerns that their children were disproportionately affected by autism spectrum disorder. A limited survey by the state health department the following year found an unexpectedly high number of Somali children in a preschool autism program. But a University of Minnesota study found that Somali children were about as likely as white children to be identified with autism, although they were more likely to have intellectual disabilities.

Around that time, health-care providers began receiving reports of parents refusing the MMR vaccine.

As parents sought to learn more about the disorder, they came across websites of anti-vaccine groups. And activists from those groups started showing up at community health meetings and distributing pamphlets, recalled Lynn Bahta, a longtime state health department nurse who has worked with Somali nurses to counter MMR vaccine resistance within the community.

At one 2011 gathering featuring Wakefield, Bahta recalled, an armed guard barred her, other public health officials and reporters from attending.

Fear of autism runs so deep in the Somali community that parents whose children have recently come down with measles insist that measles preferable to risking autism. One father, who did not want his family identified to protect their privacy, sat helplessly by his daughter’s bed at Children’s Minnesota hospital last week as she struggled to breathe during coughing fits.
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Anti-vaccine activists spark a state’s worst measles outbreak in decades


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Local community leaders should do more efforts to convince people that vaccines don't cause autism.
 
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