[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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