February 8, 2023

Central Ohio’s Measles Outbreak Was Scary. We Can Prevent the Next One.

Dr. Bradley Jackson, Plan Performance Medical Director at Anthem BCBS Ohio Medicaid

In November and December of 2022, Ohio made international news for a reason we don’t want to celebrate: We had the country’s worst outbreak of measles. A disease that is absolutely preventable through vaccination, and had once been eradicated in the U.S., was moving through central Ohio communities with alarming speed.

It was alarming because, contrary to what many believe, measles isn’t a harmless childhood disease with a funny little rash. Fever can spike to more than 104 degrees Fahrenheit — dangerous territory, especially for babies and young children. Extended fever can cause brain swelling (encephalitis) and damage that leads to developmental and learning delays.

And, as with most measles outbreaks, the vast majority of cases in central Ohio were among children age 5 and younger. Thankfully, none of the 85 cases resulted in death, but 36 were sick enough to go to the hospital. And almost everyone — all but five — was unvaccinated. Four had received only one of the two required MMR vaccines, and only one had received both doses.

Many of the unvaccinated children are in new American families, among whom vaccination rates are relatively low.

For me, the experience reveals some clear priorities for leaders in health care: We must improve rates of vaccination, especially among new Americans, and to do so we have to communicate directly with families.

Where people are still learning English and aren’t yet well connected with social institutions, PSAs urging them to get vaccinated aren’t terribly effective. A Columbus Dispatch story in January outlined efforts by public health officials and community leaders to counter misconceptions and lack of information about vaccination. One woman had been told by a religious leader that the measles vaccine contained poison. Others simply don’t know anyone familiar with the vaccine regimen practiced in the U.S.

In such situations, there is no substitute for a family health practitioner, a school nurse, a community leader, or other trusted source explaining that vaccines are not only safe but extremely important for preventing serious sickness. This responsibility is becoming more and more important as rates of vaccination against measles and other preventable diseases decline in the U.S. and around the world.

The COVID-19 pandemic and the social turmoil around it dealt a double blow to vaccination for non-COVID diseases. First, the upheavals — shuttered institutions, economic disruption and fewer social contacts — made routine vaccinations more difficult for many. And then the misplaced controversy over the COVID-19 vaccines fueled an increase in anti-vaccination sentiment, with millions rejecting not only the new vaccine but long-established ones, as well.

According to the World Health Organization (WHO), in 2021, 25 million children missed what should have been their first measles dose and another 14.7 million missed what should have been their second — both record numbers. WHO Director-General Dr. Tedros Ghebreyesus says getting immunization programs back on track is “absolutely critical.” I agree, and we in Ohio can start with our own communities.

Ironically, a measles outbreak such as we experienced in Ohio can help us, by giving clues about which communities are most at risk and how to reach them.

Thankfully, Columbus Public Health on Feb. 5 declared the outbreak over, after 42 days (two incubation periods for the measles virus) passed with no new cases reported. If we are to prevent another outbreak from happening, we know what we need to do.