By Erin K. Costello
When you look at New Zealand and New York State, you can’t help but to wonder why our outbreak was not as bad as theirs is. The majority of our outbreaks were in New York City which is about 302 square miles (or 782 sq km), and has a population of about 8.4 million. The majority of New Zealand’s outbreaks have been in Auckland, New Zealand’s largest city on the North Island. Auckland is about 425 square miles (1,102 sq km), and has a population of about 1.5 million.
At the height of the measles outbreak in NYC from Sept 2018 to May 29 this year (269 days), there had been about 550 confirmed cases of measles. This comes out to be about 2 new confirmed cases of measles a day in NYC. To date this year (259 days), NZ has had 1,324 confirmed cases of measles, with 1108 of them being in Auckland. This comes out to be about 23 new confirmed cases of measles a day in Auckland. That’s 21 MORE confirmed cases a day compared to NYC. Auckland has a much smaller population than NYC and a larger area of which the population live on. Are their vaccination rates that much lower than ours were?
New Zealand has an overall vaccination rate of about 87% with rates varying between 78-88% between 6 months of age and 5 years of age. This rate is down by about 5.06% compared to last year’s rates.
Auckland, however, has an overall vaccination rate of about 87.4% for 5 year olds, with community rates ranging from 78.5% and 90.3%. Another area hit especially hard is the counties Manukau area, where the overall vaccination rate is 89.4%. among 5 year olds. Of those in Manukau, the most at risk is the indigenous Polynesian community of New Zealand, the Maori, with a vaccination rate of only 59.4% for children 6 months of age and a rate of 84.4% for children 5 years of age.
When you break down the rates into actual numbers instead of percentages you see that in Auckland there are 5,753 children eligible to be vaccinated but only 5,027 of those have been vaccinated. In Counties Manukau there 8,597 children eligible for their shots but only 7,687 of those have received vaccinations.
According to a 2017-2018 census, New York State had an overall vaccination rate for Kindergartners of 97.2%. However, in the affected areas around NYC, the vaccination rate was only about 77% when the outbreak occurred.
Both of these highly affected areas had similar degrees of vaccination rates, however, the surrounding areas are a bit different with all of NYS at 97.2% and all of New Zealand at 87%.
One reason for the severity of New Zealand’s outbreak could be due to a MMR vaccine shortage. NZ has been suffering this shortage since early this year. According to a news article from March 2019, the Immunisation Advisory Centre line saw a three-fold increase in call volume as health professionals looked for further information on measles. Due to this increase, the Ministry of health had asked general practices throughout parts of NZ to prioritize their MMR vaccinations for those who have never been vaccinated. Officials have since changed their approach against the measles to a more targeted one. Now, according to a NZ Herald article from September 17, 2019, Medical officer of health Dr William Rainger said the strategy for managing the outbreak, specifically in Auckland, is targeted by first protecting the most vulnerable. Dr Rainger said,
"Vulnerable in terms of the likelihood of infection and vulnerable in terms of severity of disease, and that is the under 5-year-olds. So the first priority is for GPs to maintain the childhood immunisation schedule…. The second objective is to interrupt the chain of transmission - which means looking at the data that we have about who is getting the disease, where it is being transmitted geographically, and trying to target the remaining vaccine supplies to those areas and those populations."
The reason for a more targeted approach Dr Rainger said is because,
“We are not at a very high rate of disease occurrence and we need to be more targeted.” He continued, “There is a finite amount of vaccine globally, and in New Zealand, so we have to make those decisions about what is the most effective use of it.”
Rainger added that further national supplies of the MMR vaccine had arrived in the country and would be distributed this week. He expects this supply to last for the next three months and that “the next order is in January, but Pharmac is working to source more supplies from overseas”
The reason stated for the vaccine shortage is that medical centers have been ordering vaccine supplies according to demand. If there isn’t a demand for something, supplying it is a waste of money and a waste of product since vaccines to expire. The reason for a lower demand than there are children is overwhelmingly due to the anti-vaccination movement. The anti-vaccination movement has been gaining ground in western civilized countries. NYC this past year, and now NZ this year, are the results of increased anti-vaccine sentiments. Earlier this year the World Health Organization announced vaccine hesitancy as one of the top 10 global health threats. In other parts of the world where we have seen large measles outbreaks the reasons are usually due to a high population, unavailability of the vaccine, or of health care in general, out a distrust of the government.
Parents being lied to and scared into denying vaccinations puts real lives at risk. Not only are the children of anti-vaccine parents left unprotected, but so are those who cannot receive a vaccination due to legitimate medical reason. Like with any area, some children remain unvaccinated due being immunocompromised. These children have lower immunity therefore are most at risk for serious complications and death due to having measles. According to Ministry of Health, children in NZ with low immunity to measles have a 50% death rate.
Measles is the most contagious illness known to man. Those without immunity face a 90% chance of contracting the disease once exposed. The NYC outbreak did not produce and measles related deaths, thankfully, but that does not mean the outbreak was without harm and suffering for those affected. In NYC a total of 654 people to date were infected with measles with 52 of them hospitalized, including 16 who required intensive care. Of those infected, 73% were unvaccinated, 7% were not vaccinated completely, and 15% did not know their vaccination status. Almost 8% of those infected required hospitalization due to the disease.
According to the CDC,
- About 1 out of 20 children with measles get pneumonia.
- About 1 out of every 1,000 with measles will develop encephalitis that can lead to deafness or other disabilities.
- Nearly 1 to 3 of every 1,000 children infected with measles will die from respiratory and neurological complications.
There are also long-term complications from having measles. Subacute sclerosing panencephalitis is a very rare, but fatal disease of the central nervous system that results from a measles virus infection acquired in earlier life. When the U.S saw a resurgence of measles in 1989 to 1991, 4 to 11 out of every 100,000 were estimated to be as risk for developing SSPE.
These figures may seem low but it’s important to remember that In a time before the vaccine was available, nearly all children got measles by the time the were 15 years of age. About 3 to 4 million people in the US were infected each year, an estimated 400-500 people died, 48,000 were hospitalized, and 1,000 developed encephalitis.
Even though the anti-vaccine movement lie and claim otherwise, VACCINES ARE SAFE. According to the CDC, the most severe vaccine reactions, such as allergic reaction, long term seizures, coma, brain damage, deafness, or death happen so rarely that it is difficult to determine if they are caused by the vaccine or something else.
The price you pay for vaccine induced immunity is quite low. According to the CDC, the most common vaccine reactions are mild in nature, such as:
* Pain or soreness at injection site
* Lack of appetite
* Mild fever
* Abdominal pain, cough, nausea
* Headaches, upper respiratory tract infection
*Muscle and joint aches, stuffy nose, sore throat
The MMR vaccine can cause the following moderate events:
- Seizure, often associated with a fever
- Temporary pain and stiffness in the joints, mostly in teenage or adult women
- Temporary lo platelet count, which can cause unusual bleeding or bruising
- Rash all over body
The outbreak in New Zealand shows no signs of slowing down with more and more cases confirmed each week. Looking at the data coming out of New Zealand compared to the data from New York’s measles outbreak, it appears that the outbreak in the US, and NYS in particular, could have been much worse. Make no mistake about this though, there will be more outbreaks in the US, and they will become larger and worse if something is not done to stop the spread of anti-vaccine misinformation. This next outbreak could possibly be in Texas, or Ohio according to experts.
What's The Harm?