[Congressional Record Volume 140, Number 94 (Tuesday, July 19, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: July 19, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
ADDITIONAL STATEMENTS
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IMMUNIZATION
Mr. BUMPERS. Mr. President, I ask that I be allowed to enter
the following article regarding vaccination, in its entirety, into the
Congressional Record.
The article follows:
[From the Immunization Action News, June 15, 1994]
Opposition to Vaccination, Cause of Measles Outbreaks
Among the outbreaks in the current measles season, the
number of cases in persons opposed to vaccination for
religious or philosophical reasons has been particularly
high.
Although most of these cases have occurred in only two
separate outbreaks, the 269 confirmed cases reported from
January 1 through May 21, 1994 represented over 50% of all
517 measles cases reported to the MMWR during that period.
Not only have these outbreaks presented challenges for
controlling measles this year, they illustrate the continued
challenge presented by groups claiming exemption to
vaccination as states work to reach the 1996 national goals
for immunization and disease reduction.
The first and longest running of these two outbreaks began
in mid-February in Salt Lake County, Utah. It grew to affect
11 extended families and involved unvaccinated persons, age 3
months to 23 years, opposed to vaccination on philosophic
grounds. As of May 21, 93 confirmed cases were reported to
the MMWR with another 28 potential cases awaiting
confirmation. By May 1, direct transmission from this
outbreak to an extended family in Nevada had occurred. Twelve
potential cases are being investigated, all of which occurred
following a visit to one of the affected Utah families. As of
May 21, suspected cases were still being reported in the Utah
outbreak.
Additionally, two cases of measles in a Missouri family
have been linked to the Utah outbreak and one case in
Colorado has been linked to the cases in Missouri.
The other outbreak among persons opposed to vaccination
began in two contiguous counties along the Illinois-Missouri
border on April 4 when a Christian Science high school
student became ill after skiing in Breckenridge, Colorado
during a measles outbreak there. This student lived with her
family on campus at Principia College, a Christian Science
college in Jersey County, Illinois and commuted daily to the
Principia Christian Science School (grades K-12) in St. Louis
County, Missouri.
By May 21, the extended outbreak, centering around both
campuses, had resulted in 175 confirmed cases (IL, 38; MO,
137) of measles reported with another 27 potential cases (IL,
8; MO, 19) being investigated. This outbreak represents the
largest measles outbreak in 1994 within the United States.
Control measures in both of these outbreaks relied
primarily upon quarantine and careful surveillance to prevent
the spread of measles outside the groups in which it began.
Local health departments offered vaccinations which were
accepted by some individuals in the affected groups.
Established working relationships between these groups and
the local health departments allowed strict quarantine
measures to be maintained.
In Missouri and Illinois, students were confined to
designated areas of campus or home for two weeks following
exposure. Only persons with proof of immunity were permitted
to go into quarantined areas. Although Christian Scientists
generally oppose medical care, much discretion is left to the
individual and many students accepted vaccination in order to
return to classes. However, a large number of these students
did develop measles, most likely because they had received
the vaccine more than the recommended 72 hours after being
exposed (ACIP recommendations). By May 21, there was no
indication of measles transmission outside the Christian
Science community. However, since then at least two suspected
cases have been reported in St. Louis County in non-Christian
Scientists who came into contact with students from the
Principia School, one at a tennis match and one at a
restaurant where a post-tennis match celebration was being
held.
Most of the families in the Utah and Nevada outbreak live
in semi-secluded areas and teach their children at home
rather than use the public schools, making quarantine easier
to maintain. Several family members did accept vaccine rather
than risk missing work due to illness.
The large size of these outbreaks illustrates the potential
difficulties that groups opposing vaccination pose for
measles control efforts, and especially for elimination of
indigenous measles in the United States. Immunization may be
accepted by some members in such groups, particularly when
the consequences of illness may be less acceptable, i.e.,
missing work or school. In Missouri, many students accepted
immunization in order to attend school graduation.
Unfortunately, individual decisions to be vaccinated may not
be made until the outbreak is well established and its
potential impact becomes apparent. The success that State and
local health departments demonstrated in containing these
outbreaks grew from established relationships based upon
respect and understanding of the beliefs and rights of the
groups involved. Good relations permitted health officials to
learn about new cases promptly, to maintain effective
quarantine, and in some cases win acceptance of
vaccination.
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