Five things to know about the measles outbreak

The number of new measles cases in the country is on the rise, with the U.S. on track to have its worst year since public health officials declared the disease eliminated in 2000.

As of Thursday, the current outbreak has sickened 555 people across 20 states.

{mosads}And as memories of previous measles outbreaks have faded, the anti-vaccine movement has made a comeback amid the group’s concerns over vaccine safety.

All of that has set up a clash that involves public health departments, schools, religious communities and even Congress.

Here are five things to know about the measles outbreak.

States are taking the lead on prevention

The measles virus has been spreading primarily among pockets of unvaccinated children. The sharp increase has prompted a pushback against state laws that allow people to opt out of vaccinating their children for moral or religious reasons.

Almost all states grant exemptions for people who have religious beliefs against vaccinations, with 17 states making exceptions for both religious and personal or philosophical beliefs.

{mossecondads}In Washington, where there have been 74 confirmed measles cases, state lawmakers are advancing a bill prohibiting philosophical exemptions for the measles, mumps and rubella vaccine. The measure passed the House earlier this year, and was recently sent to the Senate.

On the East Coast, Maine’s legislature is awaiting floor votes in both chambers for a bill that would eliminate all nonmedical exemptions. A similar proposal is advancing in Oregon, despite strong anti-vaccine sentiments in parts of the state.

Arizona Gov. Doug Ducey (R) has promised to fight legislation that would expand exemptions in the state, which already has exceptions for religious and personal reasons.

Anti-vaccination movement is under pressure

The outbreak has shined a light on opponents of vaccinations.

“The anti-vaccine lobby has grown from a fringe group to one with its own media empire,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor University’s College of Medicine.

He said the anti-vaccine lobby is spreading misinformation, mostly unopposed, and the numbers of people becoming sick have reached a tipping point.

And the U.S. is not alone. Measles is spreading across the world, and this year the World Health Organization for the first time declared vaccine hesitancy as a top 10 threat to global health.

Anti-vaccination activists have likened public health measures, like banning unvaccinated children from schools, to the Nazi persecution of Jews.

Del Bigtree, chief executive of an anti-vaccination group called ICAN, wore a yellow Star of David at a rally in Texas last month.

His actions were criticized by the Anti-Defamation League and by officials at the Auschwitz memorial in Poland.

“It is simply wrong to compare the plight of Jews during the Holocaust to that of anti-vaxxers. Groups advancing a political or social agenda should be able to assert their ideas without trivializing the memory of the six million Jews slaughtered in the Holocaust,” said Jonathan Greenblatt, chief executive of the Anti-Defamation League.

Outbreaks concentrated in specific groups

As of April 8, New York City has confirmed 285 measles cases in Brooklyn and Queens since the outbreak began in October. Most of the cases have involved members of the Orthodox Jewish community.

The outbreak prompted New York City Mayor Bill de Blasio (D) and public health officials to declare a health emergency and mandate that families get children vaccinated against measles or pay a $1,000 fine.

Hotez compared the outbreak among the Orthodox Jewish community to a similar measles outbreak among Somali-Americans in 2017 in Minneapolis, when the state confirmed 79 cases, the most in 30 years.

According to the Minnesota state health department, more than 80 percent of the cases involved unvaccinated Somali-American children, whose parents had long been recipients of anti-vaccine propaganda.

Congress is focusing on social media

Lawmakers on both sides of the aisle are looking into how the disinformation campaigns are able to spread so quickly, and they are setting their sights on social media.

“There is a lot of misleading and incorrect information about vaccines that circulates online, including through social media,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health Committee, said at a recent hearing on Capitol Hill.

“Charlatans and internet fraudsters who claim that vaccines aren’t safe are preying on the unfounded fears and daily struggles of parents, and they are creating a public health hazard that is entirely preventable,” Alexander said.

House Intelligence Committee Chairman Adam Schiff (D-Calif.) in February pressed Google CEO Sundar Pichai and Facebook CEO Mark Zuckerberg on the issue.

Schiff said he is concerned that YouTube, which is owned by Google, and Facebook, which owns Instagram, are “surfacing and recommending messages that discourage parents from vaccinating their children, a direct threat to public health, and reversing progress made in tackling vaccine-preventable diseases.”

But so far, there have been no legislative solutions proposed, and tech companies have voluntarily begun policing themselves.

For example, Pinterest late last year began suppressing search results on vaccinations. YouTube said it would begin removing videos with “borderline content” that “misinform users in harmful ways.”

Measles can have short- and long-term health effects

According to the Centers for Disease Control and Prevention, up to 90 percent of people who are not immune will become infected if they are exposed to the virus. 

For every 1,000 children who get measles, one or two will die from it. Death rates from measles have plunged with vaccination, but that could change if vaccination rates decline further.

The disease can also have long-term health effects. About 10 percent of children with measles also get ear infections that can result in permanent hearing loss.

As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.

Some rare complications are more serious: About one in 1,000 people in the U.S. with measles develop encephalitis, or brain inflammation, that can lead to convulsions and leave the victim deaf or with an intellectual disability.