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Hawaii Dodges Measles

Vaccinations available, disease outbreaks continue

By: Katie Boon

10 April 2019

Despite the rapidly growing measles outbreak in the United States, Hawaii seems to have dodged that bullet.


159 cases of measles were reported in the United States within the first two months of 2019, according to the Center for Disease Control. Two of those cases were confirmed by the state Department of Health on Hawaii island at the end of January.


DOH officials say the incidents involved infected travellers from Washington and once they got to Hawaii, they were quarantined. The two people were only allowed to return home when officials determined they posed no risk to others. Both visitors were unvaccinated.


Vulnerable Populations


However, Hawaii could possible become more susceptible to an outbreak of measles or other similar diseases.


More people opting for no vaccinations could make the population as a whole vulnerable to diseases that were once thought to be close to being eradicated, the CDC explains.

“CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.”


The measles, mumps and rubella vaccination was given to fewer children ages 19-35 months, according to the CDC. The number children vaccinated in Hawaii dropped from 94.7% in 2015 to 90.5% in 2017.


Although, mainly in Kauai, recent media coverage has brought attention to the number of students with vaccination exemptions. According to the Honolulu Civil Beat, about a quarter of public, private and charter school students in Kauai have exemptions.


There are 16 students unvaccinated out of 16,806 attending the spring 2019 semester at UH Manoa.


Kristyn Nishimoto, a University of Hawaii John A. Burns School of Medicine (JABSOM) graduate and Kapiolani Medical Center pediatrician, encourages vaccinations to reduce the possibility of outbreaks of preventable diseases. Nishimoto stated that vaccines are mandated in order to protect vulnerable populations such as the young, the old and those who have chronic medical conditions.


Taking the issue to the state Capitol


During the 2018 Hawaii Legislature, lawmakers attempted to pass House Concurrent Resolution 157 and House Resolution 107 which would require officials to study the adverse effects of vaccines to individuals. While both resolutions died, many health professionals, including Nishimoto, opposed the resolutions. The Healthcare Association of Hawaii (HAH), which has over 150 medial organization affiliations statewide, also testified in opposition of the resolutions.


The HAH wrote that there are already systems in place to monitor vaccine safety. Adverse events post-vaccination must be reported and therefore, statistics are generated reliably.


Yet, many individuals submitted testimonies for the resolutions to voice their support of the resolutions. Quentin and Tracey Winehurst of Kapolei cited their concern about dangerous vaccine ingredients such as mercury, aluminium, formaldehyde and aborted fetal cells.


“Many adverse reactions include encephalitis, vasculitis, meningitis, anaphylactic reaction and even death,” the Winehursts wrote in their testimony. “This is a serious issue that must be addressed before we continue to be poisoned by these vaccines.”


Hawaii for Informed Consent, a nonprofit activist group, says the maximum information about the vaccines should be given to each individual so that people can choose whether vaccines are in their best interests or not.


“It is unacceptable to risk the well-being of some individuals for the benefit of other individuals,” said Laurie West, a member of Hawaii for Informed Consent.


Recommended vaccines


Most reactions to the MMR vaccine are minor and range from fevers to swelling around the injection site. Less common reactions may include long term seizures and brain damage. However, possible side effects from all vaccines are listed on the CDC website.


Paige Heckathorn, senior manager of legislative affairs for Hawaii for Informed Consent pointed out that adverse events post-vaccination are not necessarily linked to those vaccinations. She said it would be similar to someone getting vaccinated, breaking their arm in a bike accident and blaming it on the vaccination.


Hawaii State Department of Health lists other recommended vaccinations on its website including information on best age to be vaccinated along with information about other preventable diseases.

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Recent Disease Outbreak


While there may have been no measles outbreak in Hawaii yet, one of the other diseases that falled under the Measles, Mumps, and Rubella (MMR) vaccination is no stranger to the islands.


Mumps were reported in the state in March 2017, and the outbreak wasn’t declared over until October 2018. In total, over 1,000 mumps cases were documented during that stretch, with 819 of them occurring in the Honolulu county. The cases involved a mix of vaccinated and unvaccinated people.


In 2000, the CDC declared that within a 12-month period, measles was not transmitted in the United States.


“Measles as a naturally-occurring disease in the United States ha[d] been eliminated since 1980,” said Robert Jacobson, a doctor at the Mayo Clinic. “All of these outbreaks we’ve had since--including the 667 cases we had in 2014, just an outrageous number in this day and age of vaccination--were all brought from the outside.”


Before common use of the MMR vaccination, about 6,000 people died of measles infections every year.


When there are three or more cases located in the same county, it is considered an outbreak. Recently, several counties across the country have experienced measles outbreaks, including three in New York, one in Washington and one in Texas.

“Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States.”


The individual MMR vaccinations were combined in 1971. The Hawaii State Department of Health Disease Outbreak Control division advises MMR vaccinations for those who are the right age. In addition to measles, this two-part vaccine also protects against mumps and rubella.


Since 1971, mumps cases in the United States have dropped by 99 percent, according to the CDC. However, mumps has experienced somewhat of a resurgence during the past few years.

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A graph from the CDC shows the ever changing number of cases of mumps each year

In 2014 and 2015 slightly more than 1,000 people contracted mumps. The number jumped exponentially to over 6,000 people affected in 2016 and 2017.


Jacobson noted that those who are immunocompromised rely on herd immunity for their own safety from many diseases, including measles. Herd immunity is possible when enough people in a population are immune to diseases: They create a safety net around those that are not able to become immune through vaccinations, which includes those who have those diseases, are under a year old or refuse to get the appropriate vaccine.

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