Wednesday, January 21, 2015

Measles at The Magic Kingdom: Not Magic At All

Measles at Disneyland?

How did this happen? Shocked. In California?

It's not exactly magical how measles ended up at The Magic Kingdom. It's not magic at all but a numbers game.

A new study by health care provider Kaiser Permanente identifies clusters of "underimmunization" in Northern California, areas in which a significant percentage of children haven't received all the recommended vaccines. Prior research suggests up to 10% of vaccinated individuals might not have full immunity, meaning even some who got the MMR will get measles.

So it's not so surprising to hear NBC News reports 52 confirmed measles cases have been linked to the California-based theme park. Commentators have noted that a place like Disneyland, where people travel from far-reaching destinations, could result in a perfect storm of measle outbreaks across the country if not internationally.

Cue Orange County vaccine-hesitant and best-selling celebrity pediatrician, Dr. Bob "Measles? So What? It's Like Chicken Pox" Sears who took to Facebook to reassure parents the disease wasn't so awful and will only kill a few kids or as he put it "the risk of fatality here isn’t zero, but it’s as close to zero as you can get without actually being zero. It’s 1 in many thousands."  How technical. Precise. Would impress a statistician for sure. I might even borrow that for future purposes, maybe to put parents at ease about the relatively small risks of vaccination (hey, they're as close to zero as you can get...). Mind you, Dr. Sears could do the same thing but does not.

Thankfully science blogger Orac focused in on the problem with Dr. Sear's poor communications over at Respectful Insolence:
Overall, the message wasn’t so much that children shouldn’t get the vaccine. Rather, the message was that the vaccine doesn’t matter because measles isn’t so bad. This was an incredibly irresponsible message in the middle of an outbreak, and any pediatrician who makes such an argument is a crappy pediatrician. It’s tempting to throw it back at him and conclude that Dr. Bob is stupid, but I know that he’s not. He’s made his bed, and now he has to lie in it. The reason skeptics and practitioners of science-based medicine view him as antivaccine is because his every public utterance tell us that he is.
Speaking of vaccine messages...

By now the media, parents and mommy bloggers have gotten the news that vaccines (the MMR, the one that prevents measles) do not cause autism. The message has been loud and clear at least for the past few years. Still, doubts and worries plague parents even though vaccination rates hover around 92% in the US. A small percentage of parents delay or forgo their children's immunizations, a cause for concern because if those vaccination numbers dip further then "herd immunity" drops and disease can spread more rapidly. Then a trip to The Magic Kingdom turns out to be not so magic.

How to get parents to follow vaccination recommendations is not easy feat. Public health officials are worried. School officials are worried. The American Academy of Arts and Sciences is worried:
Over the past two decades, a combination of fraudulent scientific studies, irresponsible reporting, and well-meaning but misinformed citizen activists has led to a steady increase in the proportion of parents who have concerns about the recommended childhood vaccine schedule. While overall vaccine uptake rates in the United States remain high, these concerns have resulted in a significant expansion in the number of parents who are delaying, and in extreme cases even refusing, vaccines for their children. 
Harvard's Shorenstein Center
Public health-minded folks must worry about how to persuade parents to vaccinate. There's a real need to understand how parents react and respond to health communications. Obviously just getting the word out does not cut it. Debunking, sadly it is not enough. The word from communications and psychological research does not inspire much confidence in the current health communications or the state of health communications research on the matter.

Consider the 2014 study published in Pediatrics on the effectiveness of vaccine information I wrote about in May. None of the health messages increased parents' expressed intent to vaccinate in the future. Not the factual disease information. Not correct false information. Not the photos or stories of sick kids.

But what about an outbreak at Disneyland?

Could it persuade parents to rush out for an MMR?

Probably not Dr. Sear's crowd. He told them it didn't matter, they didn't need to worry about the measles. The Magic Kingdom outbreak probably won't persuade parents already quite worried about vaccines but it could influence some parents who are on the line. It would be interesting to see if a heavily-covered outbreak in the media, say at Disneyland, could persuade anyone to vaccinate. That would be a cool study.

What if you were hesitant about vaccines and you lived near an outbreak, say one in your school district, would you vaccinate? If you trust Dr. Sears and don't dread measles, then all the more interesting. Expose your child to measles (with a zero or close to zero risk of death according to the doctor) or to the vaccine (even smaller risk of death in reality)? Not ethical but would make a fascinating study.

Check out Tara Haelle's Five Things To Know About the Disneyland Measles Outbreak at Forbes.

BRAINSTORM/CRAMP: How about Disney includes an MMR in the price of admission to the Magic Kingdom? Right next to the swirling tea cups or inside Cinderella's castle?

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