A major California health provider, spurred on by the rising number of measles cases in the state, is taking the offensive to encourage unvaccinated patients to get the vaccine.
“We do not want a single case of measles if we can help it,” said Dr. Robert Riewerts, regional chief of pediatrics for Kaiser Permanente Southern California. Kaiser has plans to contact nearly 140,000 households.
Northern California-based Kaiser Permanente this week began robo-calling member households with children who have either not been vaccinated or not completed the measles, mumps and rubella, or MMR, two-dose vaccine series.
“California is in the midst of the largest outbreak of measles in over 20 years,” the automated message says. “Measles is a highly contagious and potentially deadly infection. As of Jan. 23, 2015, we show someone in your household is between 12 months and 17 years of age and has not completed and is due for the MMR series, or measles mumps and rubella vaccine. We strongly encourage you to bring your child to the closest Kaiser Permanente Pediatric Injection Clinic.”
Calls began Monday in Northern California and will continue until Friday. Then calls will begin in the southern part of the state and be done for seven days, excluding weekends. Approximately 40,000 Northern California households and more than 98,000 in Southern California will receive calls, according to Kaiser.
“This robo-call outreach that we're doing currently is to really reach out to those people that we think are candidates to get the vaccine because of our concern they might be exposed over the next two weeks,” said Riewerts.
As of Jan 28, there have been 79 confirmed measles cases in California, according to the California Department of Public Health.
California has been at the epicenter of a severe measles outbreak that experts traced back to an infected individual who visited Disneyland last month but has since spread to multiple states. Additional cases related to Dinseyland have been reported in Arizona, Colorado, Michigan, Nebraska, Oregon, Utah and Washington, with one case reported in Mexico. Those infected ranged in ages from 7 months to 70 years old.
Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, in speaking with reporters Thursday, said the number of cases of measles that have been reported so far this year raises concerns over the possibility of the disease once again becoming native to the U.S. where it was declared eliminated in 2000.
“I want to do everything possible to prevent measles from getting a foothold in the United States and becoming endemic again,” Schuchat said.
A total of 84 measles cases across 14 states occurred between Jan.1 and Jan 28, Schuchat said. A majority of the cases reported have been among those who were not vaccinated for the disease. That's once again sparked debate over the increase in the number of parents who have refused to vaccinate their children.
Vaccination critics have contended there are concerns over the safety and efficacy of vaccines and the timetable the Centers for Disease Control and Prevention recommends for young children to get vaccinated.
Riewert said the vast majority of the nearly 1 million children treated by Kaiser in southern California are up to date on their vaccinations.
“We always enjoy having patients change their mind to go from unvaccinated to vaccinated,” Reiwert said. “Anecdotally, we're seeing an increase in not only questions, but people asking for the vaccine.”
Causes for refusing the vaccine vary. Most health experts believe the recent increase can be traced to fears over the MMR vaccine and a supposed link to the onset of autism spectrum disorder, a theory that received worldwide attention in 1998 with the publication of a paper by former British surgeon Andrew Wakefield reporting evidence of a connection. The paper was eventually retracted by the Lancet in 2010 because the data Wakefield used for his findings was found to be fraudulent, and he was stripped of his medical license by the U.K.'s General Medical Council that same year.
Health providers say doubts about the safety of MMR vaccine are still present, which has led to a rise in measles outbreaks in recent years. Last year there were 23 measles outbreaks across the country, resulting in 644 cases, the largest number for any year since measles was declared eliminated here. Schuchat said 79% of the people infected with measles in 2014 had chosen not to vaccinate themselves due to their personal beliefs.
“Unfortunately the damage is done,” said Dr. Jorge Parada, director of the infection control and prevention program for suburban Chicago-based Loyola University Health System. “The idea that vaccines can give you autism penetrated very, very deeply despite there being many, many studies that said that association is not there.”
Nationally, median vaccination coverage for the 2013-14 school year in 49 states and the District of Columbia was 95% for two doses of the MMR vaccine, according to the CDC. Every state requires children to show proof of immunization before entering public school, but parents can choose to exempt their child from vaccination for either religious or philosophical reasons in 48 states.
Overall, the median exemption rate among 46 states for the 2013-14 school year was 1.8%, according to the CDC, but rates vary in communities throughout the U.S. MMR vaccine coverage among California kindergarten students for the 2013-2014 school year was 92%, according to the CDC, but coverage rates differed among counties. Coverage rates were found to be below 90% in several counties, some of which have exemption rates above 10%, according to CDPH data.
The agency recommends children get the first dose of the MMR vaccine between 12 and 15 months of age, with a second dose between the ages of four and six years. If both doses are received, experts say the vaccine has an efficacy rate of around 98%.
Before the MMR vaccine was widely used in 1963, an average of 500 kids died from measles each year in the U.S. Most health experts agree there is a low possibility of measles becoming native again to the U.S., but many raised concern that outbreaks could become more common if the number of those unvaccinated increases.
“With successful vaccines people don't know the disease, and then they no longer fear the disease and can become complacent,” said Dr. Kathyrn Edwards, director of the Vaccine Research Program at Vanderbilt University School of Medicine's Department of Pediatrics. “But measles is only a plane ride away.”
Follow Steven Ross Johnson on Twitter: @MHsjohnson