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SALT LAKE CITY — The recent measles outbreak in the United States and places across the world have brought the immunization discussion across Utah and throughout America back to the surface.
While Utah wasn’t one of the 10 states that were affected by the U.S. outbreak, state health officials worry it’s only a matter of time before a similar outbreak reaches the state.
“I’m surprised we haven’t had a measles outbreak yet associated with what’s going on,” said Rich Lakin, immunization program director for the Utah Department of Health.
According to the Centers for Disease Control Prevention, there have been 101 cases reported in 10 states (most reported in Oregon or Washington) in 2019, as of Thursday. In all, there were 372 total cases in all of 2018.
A larger outbreak in the Philippines in January claimed more than 70 lives and more than 4,000 were infected, The Guardian reported on Tuesday. Ukraine health officials reported Wednesday that eight people died from measles in their country since the start of 2019, according to the Associated Press.
In Utah, two minor measles outbreaks reached the state in 2011. In all, about a dozen cases were reported in northern Utah, according to a 2013 CDC report. The agency wrote that the outbreak highlighted "the critical need for appropriate vaccination."
"The Salt Lake County outbreak began when an unvaccinated traveler from the United States developed measles on returning to the United States and infected four other unvaccinated persons," the report stated.
Utah Department of Health numbers show most Utah parents choose to have their children immunized, while a growing number of parents in recent years have advocated that it’s too risky.
So how many Utah children aren’t adequately vaccinated for the disease?
In 2017, there were 27,539 K-12 students in Utah schools who hadn’t received the two recommended MMR (measles, mumps, rubella) shots, according to the Utah Department of Health. That’s about 4.4 percent of the 629,587 public students enrolled that year. Most of the students who weren’t properly vaccinated had exemption waivers.
State health officials aren’t sure exactly how many current students haven’t received both shots because they have to sift through reports they receive from all Utah schools on how many students have been adequately vaccinated, have vaccination exemptions or just haven’t had the vaccines.
That means 95.6 percent of students are considered “adequately vaccinated” for the disease, which is a tick above the department’s goal of about 95 percent of students across the state.
We’re pushing the envelope ... We’re still on the strong side of immunizations, but I think it’s a pretty prime example of why you see the outbreaks.
–Rich Lakin, immunization program director for the Utah Department of Health
But Lakin said he’s heard from concerned parents that their child’s schools or classes may have pockets less than the desired “herd immunity” threshold, which could make their children at risk for the virus even with a high number of vaccinated children.
For example, the CDC wrote 96.4 percent of children attending public school in Utah had received both MMR vaccines around the time of the 2011 outbreak.
“We’re pushing the envelope,” Lakin said, of the situation now. “We’re still on the strong side of immunizations, but I think it’s a pretty prime example of why you see the outbreaks.”
The state also reported 88.7 percent of 19- to 35-month-old children had received the first dose of the MMR vaccine, which ranked Utah 45th out of 50 states for 2017.
The rise of exemptions
The state health department reported 2,617 out of 48,994 public kindergarten students (5.3 percent) and 2,868 out of 52,250 seventh-grade students (5.5 percent) had exemptions for two immunization benchmark ages in Utah’s school systems. In all, 90.9 percent of Utah’s public school kindergarten students and 92.4 percent of Utah’s seventh-graders were what the state considers “adequately immunized.”
In Utah, parents can receive a waiver to not have their child immunized for three reasons: medical, religious and personal, Lakin explained. In its Nov. 2018 report, which notes 2017 state numbers, the health department reported personal reasons accounted for 96 percent of exemptions for both kindergarteners or seventh-graders, while medical only account for 3 percent.
State health department officials have seen a rise in parents who have asked for exceptions over the past few years. They say it’s mostly due to those who are opposed to vaccines, commonly known as the "anti-vaxxer" community.
Vaccine Freedom Utah founder Kristen Chevrier told KSL TV in 2018 that she started her group to help Utah parents know their rights about vaccinating children.
“The goal is not necessarily to cut back on vaccinations; the goal is choice, information and choice. So informed consent,” she said at the time.
On her website, she argues vaccines aren’t held to the same testing standards as Federal Drug Administration-approved drugs (though the CDC states it goes through an approval process), and it’s irresponsible to vaccinate children with certain medical conditions, such as various allergies, genetic mutations or illnesses. In short, anti-vaccine groups say they don’t believe vaccines are safe.
The amount of exemptions in Utah schools isn’t the only indicator that some Utah parents don't favor vaccines. In addition to the initial MMR vaccines, Utah rated in the bottom 10 in the U.S. for DTaP (diphtheria, tetanus and pertussis), polio, H. influenzae type B, as well as 4, 5 and 7-vaccine series among 19- to 35-month-olds.
The series shots are a combination of the typical shots recommended by doctors. Utah ranks much higher for hepatitis B birth dose (16th in the U.S.) and the rotavirus vaccine (17th overall).
In 2018, the Public Library of Science Medicine rated Salt Lake City and Provo as hotspots for anti-vaccination. A heat map showed Utah, Arizona, Idaho and the Pacific Northwest as primary regions in the west for anti-vaccination. The report showed Utah had a growing amount of non-medical exemptions for vaccines; that was just behind Oregon, Idaho and Wisconsin among the states who report non-medical exemptions.
State medical officials like Lakin believe there's no coincidence that outbreaks are happening at the same time vaccine exemptions are rising. They worry that if the measles virus reaches Utah, it will spread quickly among those not properly vaccinated because of how contagious the disease is.
“The trend is occurring because you don’t see the diseases anymore, so why do you think it’s important to keep getting vaccinations? The reason you don’t see the diseases is because of vaccinations,” Lakin said.
For now, Lakin and other state officials advise parents to vaccinate their children and continue to hope the outbreak doesn't reach Utah.