Jun 05 2017

Minnesota Measles

Measles graph 1There is currently a measles outbreak in Minnesota. This was, unfortunately, entirely predictable – not, of course, that an outbreak would occur specifically in Minnesota, but that we would start to see outbreaks in communities with low vaccination rates.

So far Minnesota has seen 73 cases of measles. This is more than any year in the last 20 years (or more, that is how far back the tables go). In fact, that is more than all Minnesota cases combined in the last 20 years (56).

Nationwide we hit our low point for measles in 2004 with only 37 cases, all imported from other countries. This means that measles we eliminated from the US, with no native reservoir and no endemic cases. Measles, of course, has not been eradicated from the world and so we can still have imported cases. Thirty seven cases is down from the millions that would occur each year prior to the introduction of vaccines. The graph shows reported cases, which were as high as 800 thousand, but the CDC estimates that the real number was much higher as most cases went unreported.

There is no mystery what is going on – the modern anti-vaccine movement has been effective in spreading false fear about vaccines. Since 2004 the number of measles cases has been climbing. The recent peak was in 2014 with 667 cases, due largely to the Disney outbreak.

A Vulnerable Community

Something else happened in 2004 – Andrew Wakefield visited Minnesota. There is a Somali community there and they had been experiencing a relatively high number of cases of autism. They did not understand why there was a cluster of cases, and the cultural barrier complicated efforts to provide answers. I first wrote about this apparent cluster in 2008. In 2013 a long term study confirmed that there is a cluster in Minneapolis in general, but in greater numbers among Somali children.

There is also a cluster among Somali immigrants in Sweden, but not in other locations. The cause of these clusters is not currently known. Preliminary evidence suggests that low vitamin D levels may be playing a role, which makes sense for a dark-skinned population migrating to higher latitudes. It is also possible that the population simply has a higher genetic predisposition to autism which is just being recognized when they move to countries with better access to health care and services.

In 2004 the Minnesota Somali community had high vaccination rates, >90%. Then, after Wakefield’s visit, fear started spreading through the community that vaccines were the cause of autism. Vaccine compliance plummeted, and today less than half of Somali children in Minnesota are vaccinated.

This represents the predatory targeting of a vulnerable community by an ideological group for propaganda purposes. There is a direct correlation between anti-vaxxers targeting the Somali community and dropping vaccine rates, followed predictably by disease outbreaks.

The only thing we can do now is reach out to this community with efforts to educate them about the safety of vaccines in the hopes that vaccination rates will increase. However, once a fear is instilled it is difficult to eradicate. That is the more pernicious virus at work here.

This episode and the entire anti-vaccine movement also represents the hidden risk of the alternative medicine / appeal to nature narrative which is currently on the upswing. Ideas have a lot of cultural inertia, especially once they become embedded to the point that many people just take them for granted, and incorporate them into their world view and self-identity.

The notion that medical authorities are compromised and cannot be trusted, but that purveyors of natural cures are trustworthy is nothing but marketing propaganda for snake oil. And yet this propaganda has been remarkably successful, because it is selling an emotionally compelling narrative. That narrative is not aligned with reality and has tremendous potential to cause harm.

The Somali measles outbreak is just one tiny example.

8 responses so far

8 thoughts on “Minnesota Measles”

  1. Egstra says:

    The Somali community has been doing an impressive job in providing education/information about autism and about vaccinations. The vaccination rates are going up rapidly. Unfortunately, anger about the outbreak has been directed toward the community, not to the anti-vaxxers who have preyed on them.

    Your article states that autism rates are higher in the Somali community. I believe that’s inaccurate. “The study’s data revealed that 1 in 32 Somali and 1 in 36 white children aged 7 to 9 were identified with autism in 2010 — numbers that are statistically indistinguishable, according to the researchers.” Those Somali-American children diagnosed with autism have been reported to be lower functioning than white children. Some people have suggested that’s a result of the children speaking Somali at home and thus doing less well on tests; I haven’t seen any data to support that idea.

    https://www.minnpost.com/second-opinion/2013/12/autism-highest-among-minneapolis-somali-and-white-children-u-study-finds

  2. RickK says:

    Apologies for brief tangent:

    Steve, the background on this leads to discussion on the “Gillberg Affair”. Could be an interesting topic and ethics discussion for the future. It certainly has enough click bait headlines – destruction of data, “FOIA”-type petitions, and Scientology.

  3. MaryM says:

    Taking advantage of a refugee community is about the lowest form of scumbaggery I can imagine. But let’s note that these opportunistic infection peddlers include the Organic Consumers’ Association as well. https://www.vox.com/science-and-health/2017/5/10/15591410/minnesota-measles-anti-vaccine-public-health-lessons

    Wakefield is the easiest name to point to. But the fellow travelers deserve to be scorned as well.

    But besides the obvious damage to public health, one of the things that worried me was that these minority immigrants were going to be targeted by anti-immigrant groups because of this. And that is also *exactly* what happened. Now this community is being used as a pawn of bigots. That has serious consequences as well. http://www.washingtontimes.com/news/2017/may/11/measles-minnesota-its-borders-stupid/

    There are people who keep telling me I have to be nicer to nonsense peddlers. I cannot even think about these despicable liars with anything less than seething rage. The harm from them is real and lasting. There is no amount of civil discussion that will make them stop. They need to be publicly shamed loudly and often.

  4. edwardBe says:

    MaryM: “I cannot even think about these despicable liars with anything less than seething rage. The harm from them is real and lasting. There is no amount of civil discussion that will make them stop. They need to be publicly shamed loudly and often.”

    Yes, it makes me want to “get a rope” as the Pace Picante commercial used to say, especially when it comes to antivaccine pediatricians, but that would be even more unconscionable than what they are doing and would make things even worse by creating martyrs.

  5. Orion39 says:

    Steve – Do you think there is potential for legal action against Wakefield? He would probably argue that it’s free speech, and he might be right, but it does seem like he is directly responsible for harming people through misinformation.

  6. Fair Persuasion says:

    Factors which could effect current Somali immigrants include the 1990’s famine and civil war. Diseases associated with malnutrition and tuberculosis were rampant. The Somalis’ practice female genital mutilation and have one of the highest maternal mortality rates in Africa.

  7. Jason says:

    Educate first, fine heavily if non-compliance persists. This medievalism needs to stop.

  8. Funkenet says:

    At least the silver lining to this is the outbreak finally scared my sister into vaccinating both of my nephews.

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