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Measles outbreak in Somali American community follows anti-vaccine talks

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2378 (Published 16 May 2017) Cite this as: BMJ 2017;357:j2378
  1. Owen Dyer
  1. Montreal

The US state of Minnesota is facing its largest measles outbreak in nearly 30 years, with 58 cases reported over the past month, including 14 admissions. All but three of the cases occurred in unvaccinated children under 10, mostly in the 32 000 strong Somali American community around Minneapolis.

The community’s child vaccination rates for measles, mumps, and rubella (MMR) have plummeted from 92% in 2004 to 42% in 2014, amid fears that its children have unusually high rates of autism.

These concerns have attracted the attention of anti-vaccine activists, including the disgraced former UK gastroenterologist Andrew Wakefield, who held at least two meetings with Somali community groups in Minnesota in 2010-11, when their vaccination uptake was falling quickly.

Efforts by anti-vaccine activists continued even during the outbreak. On 30 April, Mark Blaxill, founder of the anti-vaccine Canary Party, addressed a crowd of roughly 90 parents and 40 activists at a Somali restaurant in Minneapolis, telling them how to opt out of mandatory vaccinations through a “philosophical objection.”

The advice came as Minnesota’s public health department was urging unvaccinated people to take the MMR as soon as possible because, even after infection, it can prevent measles developing if taken within 72 hours.

“Unfortunately, the Minnesota Somali community has been targeted with misinformation about vaccine risks,” said Minnesota’s health commissioner, Ed Ehlinger.

Two local pediatricians attended the 30 April meeting and attempted to make a case for vaccines but were booed and heckled, said Kristen Ehresmann, director of infectious diseases at the Minnesota Department of Public Health. She told The BMJ that, at the previous meetings involving Wakefield, public health officials had been kept out by guards. Media were also barred from Wakefield’s events, said Minnesota’s Star Tribune newspaper.

Vaccine skepticism was rare in the Somali Minnesotan community until 2007, when Minneapolis education authorities revealed data showing a disproportionate number of Somali children in special education classes. Fears grew that the community had unusually high autism rates, and anti-vaccine activists swiftly became involved.

In 2011 a study sponsored by the University of Minnesota found that autism spectrum disorder rates among the state’s Somali children were statistically similar to those in white children although higher than in Hispanic and other black children.1

While vaccine uptake among Somali Minnesotans has halved since 2007, no sign of a corresponding decline in autism rates has occurred, said Ehresmann. “Unfortunately, the implications of that haven’t yet sunk in,” she told The BMJ.

But the measles outbreak was shifting perceptions at last, she said. Weekly MMR vaccination rates among Somali American children have climbed from 30 or 40 a week in March to about 500 a week in May.

However, the outbreak may now be spreading beyond Minneapolis and the Somali community to other unvaccinated groups, as possible cases are suspected in Le Sueur County and four cases have been confirmed among unvaccinated siblings in rural Crow Wing County.

Minnesota’s measles incident command team has identified about 7000 people exposed to the virus, of whom roughly 500 have been asked to limit contact because they lack immunity. A Minneapolis day care center that refused to cooperate with public health instructions was temporarily closed by licensing authorities at the team’s request.

This year US anti-vaccine activists have been energized by the election to the presidency of one of their own in Donald Trump. The president, who linked vaccines to autism in Republican primary debates,2 met Wakefield shortly before the election. Afterwards, Wakefield, who now lives in Texas, said that Trump had told him that he was “on our side.”3

Measles was declared officially eradicated from the US in 2000. Cases this year are on course to be the highest in a decade except for 2014, when measles ravaged the unvaccinated Ohio Amish community. Measles has also surged in drought struck Somalia in recent months. The World Health Organization estimates that the disease claimed 134 200 lives globally in 2015.

Contacted by the Washington Post, Wakefield denied any culpability for the Minnesota outbreak. “The Somalis had decided themselves that they were particularly concerned. I was responding to that,” he said. “I don’t feel responsible at all.”

Wakefield was struck off in the UK in 2010 for deliberately falsifying research to suggest that the MMR vaccine caused autism.4 Attempts by The BMJ to reach him for comment were unsuccessful.

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