Science Friday - What’s Behind The Measles Outbreak In Florida?

Episode Date: March 4, 2024

The United States eliminated measles back in 2000, but it still pops up every now and then. According to the Centers for Disease Control and Prevention, a total of 35 measles cases across 15 states had been reported this year as of February 22. Early last month, a measles outbreak began at an elementary school in Broward County, in southern Florida. As of February 28, the Florida Department of Health reported 9 cases for Broward County—out of 10 for the whole state.Measles is one of the most infectious diseases in the world, and it has a safe and effective vaccine called MMR—for measles, mumps, and rubella—that saves lives. Kids usually get the vaccine early in life, and it provides lifelong protection.But childhood vaccination rates have declined in some areas, so preventable diseases like measles are on the rise. In Florida, the state’s surgeon general, Dr. Joseph Ladapo, has been criticized for how he’s handling the outbreak—for example, by not explicitly encouraging parents to get their kids vaccinated.So how did the measles outbreak in Florida get to this point? And is it a reflection of a broader public health risk?Ira talks with pediatrician Dr. Rana Alissa, who is vice president of the Florida Chapter of the American Academy of Pediatrics, and an associate professor at the University of Florida in Jacksonville. He is also joined by Dr. Paul Offit, pediatrician and director of the vaccine education center at the Children’s Hospital of Philadelphia.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

In Florida, vaccine rates are going down and measles cases are going up. The first disease to come back is measles because it is far and away the most contagious of the vaccine-preventable diseases. It's Monday, March 4th, and you're listening to Science Friday. I'm sci-fi producer Rasha Irides. Back in the year 2000, measles was declared eliminated from the U.S., meaning it wasn't constantly present anymore, but cases still pop up every now and then. According to the CDC, as of today, 16 states have reported 41 measles cases this year alone. And in February, a measles outbreak began at an elementary school in Broward County in southern Florida. So far, Broward County has nine cases out of 10 for the whole state.

Here's Iroflato. You know, measles is one of the most infectious diseases in the world. And it has a tried and true vaccine called MMR for measles, mumps, and rubella. That saves lives and kids usually get the vaccine early in life. Well, not so much it appears. Let's take Florida. Surgeon General, Dr. Joseph Lattapo, has been criticized for how he's handling the outbreak. For example, by not explicitly encouraging parents to get their kids vaccinated.

So how did Florida get to this point? And is it a reflection of a broader public health crisis? Joining me to talk about this are my guest, Dr. Rana Alyssa, pediatrician, vice president of Florida chapter of the American Academy of Pediatrics, associate professor at the University of Florida in Jacksonville. Welcome to Science Friday. Thank you, Ida. Thank you for having me. And Dr. Paul Offutt, pediatrician and director of the Vaccine Education Center at the Children's Hospital of Philadelphia in Pennsylvania. Welcome back to Science Friday, Dr. Offit.

Thank you, Ira. It's my pleasure. Dr. Alyssa, let me begin with you. How concerned are pediatricians in Florida about this and how frustrated are they? We are very, very concerned. We've been sounding the alarms for a long time now, having fear of going through this, exactly this crisis. I'm going to call it crisis because the numbers are not decreasing. Actually, they are going up. So we are very concerned. And regarding the frustration, we are frustrated because unfortunately we're having conflicted messages from the leadership of our state. That's very interesting. Dr. Raffet, how dangerous is measles? Fill us in on that.

Sure. So before there was a measles vaccine in 1963, every year in the United States, three to four million people would suffer measles, mostly children less than 15 years of age. Every year, 48,000 would be hospitalized and a 500 would die. When they died, typically they died of pneumonia or encephalitis or severe dehydration. It was a severe and common infection, which fortunately, as you noted, we eliminated by the year 2000. Unfortunately, because there's been an erosion in vaccine rates, we're seeing it come back. Well, let's talk about that. Why is there, why are outbreaks like this happening? You say there's an erosion in vaccine rates. Why is that? There was a study that was published recently by the CDC showing that there has now been an increase in parents choosing

non-medical exemptions, meaning philosophical exemptions or religious exemptions to vaccination. The highest it's been in a long time. And with that erosion and vaccine rates, as you note, the canary in the coal mine, the first disease to come back is measles because it is far and away the most contagious of the vaccine-preventable diseases. To put that in perspective, it has a contagiousist index. And by that, what I mean is how many people would you infect in a single day, if you're infected and everybody you come in contact with is susceptible, the answer is 18. For diseases like COVID or flu, it's more like two or three. This is far and away the most contagious disease. When you see one case, you should be worried because it can exponentially

increase. You have come on this program many times over the years talking about how people are refusing to get their kids vaccinated because of a supposed connection to autism. Is this one of those cases or are there conspiracy theories here? I think this is something else. I think what happened during the COVID pandemic is we mandated vaccines. And that robbed a lot of people the wrong way. It was a matter for them of personal freedom, bodily autonomy. And I think we kind of leaned into a libertarian left hook. As a consequence, anti-vaccine groups are far better funded than they ever have been because they've gotten funding from that group, meaning people who see this as a matter of individual freedom. I think the Florida State Surgeon General, when he is very lax about vaccination or very lax about

isolation and quarantine, it's that sort of bizarre notion, if you will, freedom. To add, this has been an ongoing issue before COVID vaccine. And the reason is just the, I don't know if I want to call it conspiracy theory, but somehow there is, they linked, people link the MMR vaccine to autism. But you know, there are several research to talk about the link between MMR and autism, and they have been zero. It's not like, you know, it's minimal or it's just, you know, like small amount or small fraction. No, it's a zero. There is no link between MMR and autism. You know, we had a very famous case, Dr. Raffat, when you were on our show last time, many years ago, talking about this. And we had a listener calling in about

why she did not want to get her kids vaccinated. And she said simply, I just don't trust anything my government tells me. Isn't it that unfortunate? Dr. Alyssa, do you think that's what's happening here? Yes, definitely. There is an increase. The anti-vaxxer movement is what actually is making everything worse, you know, when it comes to vaccines. You know, I want to mention that you go, Google, ask question about vaccine and Google it. You're going to see all these videos, and they are compelling, you know, like they really convincing that you should not be vaccinating your child. And unfortunately, they are allowed to be there. It's because of, you know, it's freedom of speech and all of that. But people choose to listen to those instead of listening to their pediatricians and

to their CDC and to the American Academy of Pediatrics and all these researchers who know more than these just sporadic videos that spreading false information, completely false information. Do you think if the Surgeon General in Florida were to take a more active, proactive, pro-active, pro-vaccine stand that things might change? Absolutely. Absolutely. 100%. And, you know, like people who are questioning, let's say not, they're not 100% sure if they want to vaccinate or not. They would look and see, okay, if the physicians among themselves are not on the same page, why would we believe this one, not that one? We should be on the same page. We have tons of evidence. We have tons of research,

tons of data talking about how safe is the vaccine, how effective is the vaccine. Instead of being all together, we have our surgeon general, unfortunately. It's very unfortunate that is giving the very opposite message. So the surgeon general is saying don't get the vaccine? The surgeon general is giving parents a choice, and there is nothing wrong with that. But when the choice is if you're going to send your unvaccinated child to school, where there are some sick kids in the school that cannot, for medical reason, get vaccinated,

They probably have cancer. They probably have, you know, other immunodeficiency diseases. They're going to risk their lives, you know. You're risking the unvaccinated children life and risking other sick people's lives, adult people who could not get vaccine as children, you know, for medical reason. Our surgeon general is given the ultimate choice to parents. Dr. Offit, what's your take on this? Well, I think, I do think that anti-vaccine activity in many ways is an all-time high. And really, there never was a politics of the anti-vaccine movement. On the left, it was always, you know, sort of all things natural. I don't want to be inoculated with anything that has like a manufacturing residual or a preservative or an adjuvant. And so the California outbreak, for example, of measles in 2014, 2015, that started in the area around Disneyland, which was a very much less.

left-leaning area. That was an example of that. But that is not what's going on now. This is a right-leaning phenomenon. And the right has, when they rejected about vaccines, it's been for this reason, this sort of libertarian government off my back, don't tell me what to do. I mean, if you look what happened during the COVID pandemic, you were much more likely to be hospitalized and die if you lived in a county that was heavily red as compared to one that was heavily blue. It was called at one point, red COVID. That's what's going on now. And that's where all the funding is coming from. If you look, for example, Eric Trump in the last few years stood up and said, if you choose not to get a vaccine, know that the Republican Party is behind you. What is that

about? It's just been hard to watch this dramatic shift to the right. How is the vaccine supposed to work, Dr. Offutt? Well, so measles is a long incubation period disease. Incubation period from the time when you're exposed to the time that you develop symptoms. You can eliminate those kinds of diseases from the face of the earth. Smallpox is a long incubation period disease, which we've eliminated. Polio is a long incubation period disease. You'll never eliminate short incubation period diseases like influenza, respiratory, and synestitial virus COVID.

So the way the measles vaccine works is that you induce memory cells, which are long-terming and can protect you against even mild disease. For short incubation period diseases, memory is not enough. You need to have high titers or high levels of antibiotics. bodies at the time of exposure, and that doesn't last very long. And so that's what you see with COVID. You're protected against mild and severe disease for three to six months after vaccination or natural infection, but you're protected against severe disease for a much longer period of time. So the way of measles vaccine works is that because all you need is memory and memory is long-lived,

you can eliminate measles. So here's the most contagious of vaccine preventable diseases that we eliminated with vaccination by the year 2000. And what is about herd immunity? We hear that thrown around a lot. How does that work here? Right. So herd immunity means a critical percentage of the population has been vaccinated, which then does not allow the virus to spread from one person to the next. For a disease like measles, if you can get 95 to 96 percent of the population vaccinated, you can really eliminate the disease. That really doesn't work well for short incubation period disease. So look at rotavirus, for example. Rotavirus, another short incubation period disease, probably not.

95% of children are vaccinated in this country. That is not a virus that creates variance. And so we virtually eliminated hospitalizations. But the virus still spreads in the community. It still causes mild disease. That's what you would hope to get from this vaccine. Dr. Alyssa, where do you think we should go from here? I mean, if people are making a choice not to get vaccinated, I've always found it's very hard to change people's minds if they don't want to do it. It is. It's extremely hard. It's extremely difficult, exactly like what Dr. Offutt said. It's becoming, unfortunately, it's becoming political. And I have to agree with this 100%.

I wanted to repeat what Dr. Rosnick, the former president of American Medical Association, said about a couple of years ago. We said it's becoming very crowded in the physician exam room. What happened to like patient listening to their physicians? What happened to parents listening to their pediatricians? You know, we used to be like pediatrician was part of the family. Now we don't anymore. So we have, in addition to insurance issues, in addition to people not listening, now we have politics involved.

So I think changing mind is very, very difficult. I just hope we can have more open discussion because, you know, like anti-vaxxers, they feel offended very quickly and they don't want to listen because they already set up their mind. I just would like them to have open conversation, be open-minded. Let's talk. Let's talk. You hear the pediatrician who has been doing this for a very long time. Please follow the experts in the CDC. Follow the American Academy of Pediatric. If the CDC recommended and vaccinated trial to stay at home for 21 days because there's an outbreak, please stay at home. I want to expand this picture, Dr. Offutt. It's no secret that the state of public health, the health care system in the United

States, is it's in trouble itself. I would say it needs some medication. Does this measles outbreak tell us about that or mirror the state of public health in the U.S.? I think it's more what Rona just said, which is this loss of trust in public health agencies, you know, not just the CDC and the FDA, but also sort of locally with your physician. I think that's what's happened here. I mean, the fact that the matter is we had the same public health system that eliminated measles from this country in the year 2000. I just think that what's happened is science is kind of losing its place as a source of truth. People just declare their own truths. Science has become just another voice in the room to a level I've never imagined before where you'll see people, including people in the world of

science who will stand up in front of Congress and say something that's just blatantly wrong. So I've never seen anything like this. We're like entering this post-truth era, and I think that's where we're stuck. Are we going to see any other diseases making a resurgence, do you think? So you have anti-Baxers movement. So we have all the vaccines. You think about any vaccine you have. So you might have pneumonia from the strepnoa not being vaccinated.

Edge flu because they're not getting itch flu as children. That's two and four and six months of life. maybe hepatitis feed, God knows. Dr. Offutt, you agree? You know, that that's a triple dose. Mumps Rebella are included in the measles. Might we see those come back? Right.

So we eliminated Rebella from this country by 2005. There's still mumps still circulates. I think you'll probably see more Mumps case. The one that worries me is the one that you saw occur a couple years ago in Rockland County, New York, which is polio. That was a 27-year-old man who never left this. country because the polio virus, at least this so-called revertent polio virus, still circulates. It was in the wastewater in the area he lived. It was in the wastewater in surrounding counties.

If you look in the wastewater of many cities in this country, you'll see this so-called revertent strain of poliovirus that itself can cause polio. Drop polio immunization rates far enough, and that's what happened in Rockland County. Immunization rates were 30% in that county, and you saw polio come back. These are not diseases you want to relive. So if I hear it correctly, you're saying that basically health care has been politicized, and unless we unpoliticize it, we're going to be staying in this state of doubt. Right. I think that over the last few years associated with the COVID pandemic, we have lost the public's trust, or at least we've lost a critical percentage of the public's trust. And we just have to figure out why and how we can get it back because there's a lot of stay.

Last word, Dr. Alyssa, from you. We lost the trust and I hope to gain it back. We need, we can do it. We can't do it alone because we lost it tremendously during COVID and it doesn't seem that it's coming back. We need the leadership. We need to start since it's political. It has to start from the president's office down. And it's not just Florida. There are what outbreaks in 15 states. Yep, exactly. And it's going to be more. It's going to spread. Like I said, from the beginning, we've been sounding the alarm and it's getting worse and it's going to continue to get worse unless we fix this. I want to thank both of you for taking time to be with us today and having a great conversation.

Thank you so much, Ira. Nice to meet you, Dr. Offutt. Thank you, Erin. Nice to meet you, Rana. Dr. Rana, Alyssa, pediatrician, vice president of Florida's chapter of the American Academy of Pediatrics and Associate Professor at the University of Florida in Jacksonville, Dr. Paul Offutt, pediatrician and director of the Vaccine Education Center at Children's Hospital in Philadelphia, Pennsylvania. Lots of folks help make this show happen, including Sandy Roberts, George Harper, Annie Niro, Jason Rosenberg.

On tomorrow's episode, unraveling how Baleen whales, like humpbacks, sing their songs. I'm CyFRI producer Rasha Irides. Catch you tomorrow.