1

Hot Topics for Advanced Instruction:

Vaccination Rates and Outbreaks

The 2014-15 measles outbreak highlights the connection between vaccination rates and outbreaks
of contagious infectious diseases.

 Measles has been “eliminated” in the United States by vaccinations. As we discussed in

Video Lecture 2, there is a highly effective vaccine for measles. Because of this vaccine and
high vaccination rates, in 2000, measles were designated as “eliminated” in the United
States. This means that there isn’t any endemic or normal level of measles within the United
States anymore; all measles cases that occur in the United States are brought in from
outside the country.[1]

 New outbreaks are occurring. In recent years, there have been several measles outbreaks
in the United States. And in 2014, an infected person at Disneyland started an outbreak that
spread to more than 100 people. Why did this happen?[2]

 A social component of these outbreaks is a reduced measles vaccination rate due to

vaccine refusal. As Video Lecture 2 indicated, the factors that affect the spread of an
infectious disease include biological factors. Here, that includes the highly contagious
nature of the measles virus and the 97% immunity produced in people by the measles
vaccine. But other social and environmental factors also affect whether a measles outbreak
will occur. This includes environmental factors, like the fact that an infected person visited a
crowded amusement park where she came into contact with many people. It also includes
social factors that affect vaccination rates, like the fact that some of the people exposed to
the virus had chosen not to vaccinate themselves and/or their children for measles.[3]

 Vaccination rates are a good example of how the success of our responses to
contagious infectious diseases also has biological, social and environmental
components. Here, the biological component is the direct effect of the vaccine on the body.
The social and environmental components include the need for effective delivery of the
vaccinations, for legal rules requiring vaccination, and for public education on why people
should have the vaccination.

These materials will help you explore the connections between vaccination rates and outbreaks.

(1) Understanding the 2014-15 measles outbreak and the connection with measles
vaccination rates:

 To get a snapshot view, look at this map showing the extent of the 2014-15 measles
outbreak: U.S. Multi-State Measles Outbreak 2014-15, Centers for Disease Control and
Prevention, http://www.cdc.gov/measles/multi-state-outbreak.html

 Then, check out this webpage describing the status of measles, the measles vaccination, and
vaccination rates in the United States: FAQ about Measles in the United States, Centers for
Disease Control and Prevention, http://www.cdc.gov/measles/about/faqs.html

[1] FAQ about Measles in the United States, Centers for Disease Control and Prevention, http://www.cdc.gov/measles/about/faqs.html
[2] U.S. Multi-State Measles Outbreak 2014-15, Centers for Disease Control and Prevention, http://www.cdc.gov/measles/multi-state-outbreak.html
[3] FAQ about Measles in the United States, Centers for Disease Control and Prevention, http://www.cdc.gov/measles/about/faqs.html; U.S. Multi-State Measles Outbreak 2014-15,
Centers for Disease Control and Prevention, http://www.cdc.gov/measles/multi-state-outbreak.html
 2

 This on-line interactive graphic shows how vaccination rates affect the spread of measles in
a community: Rich Harris, Nadja Popovich, & Kenton Powell on the Guardian U.S. Interactive
Team, Watch How the Measles Spread When Kids Get Vaccinated – and When They Don’t, The
Guardian (Feb. 5, 2015), http://www.theguardian.com/society/ng-
interactive/2015/feb/05/-sp-watch-how-measles-outbreak-spreads-when-kids-get-
vaccinated

 See what our experts have to say about vaccinations. Under the “Ask the Experts! Video
Interviews” link on the left side of the Coursera page; Dara Lieberman and Rich Hamburg of
Trust For America’s Health discuss the reasons for the resurgence of measles.

 This news article explains the risks for vaccinated people during outbreaks: Katie M.
Palmer, Why did Some Vaccinated People Get Measles at Disneyland? Blame the Unvaccinated,
Wired (Jan. 26, 2015) http://www.wired.com/2015/01/vaccinated-people-get-measles-
disneyland-blame-unvaccinated/

 This news article discusses changes in policy concerning measles vaccinations since the last
big U.S. outbreak in 1989-91: Margaret Talbot, Not Immune, The New Yorker (Feb. 16,
2015), http://www.newyorker.com/magazine/2015/02/16/immune-3

(2) Exploring the role of vaccination in protecting the community & the concept of “herd
immunity”

 Start by playing this game: Vax is a free online game that is perfect for visualizing how
contagious infectious diseases spread and seeing the effects of vaccination and quarantines.
A contagious infectious disease is spreading among a network of people, and you try to stop
it by vaccinating and quarantining people before the disease infects the entire network. Play
at http://vax.herokuapp.com

 While you’re playing, observe which strategies are most effective in stopping the spread of
the disease. Where should you target your responses for maximum results? What is the role
of vaccination versus quarantine?

 Next, look at Vax’s explanation of herd immunity:

http://vax.herokuapp.com/herdImmunity

(3) For a more detailed, technical understanding of vaccination rates and herd immunity,
you can read these articles:

 This article offers a more technical explanation of herd immunity: Paul Fine, Ken Eames &
David L. Heymann, “Herd Immunity”: A Rough Guide, 52:7 Clinical Infectious Diseases 911-16
(2011), http://cid.oxfordjournals.org/content/52/7/911.full

 Why do we have any degree of “herd immunity” in the United States? This statistical study
documents the sharp decline in cases of measles and other contagious infectious diseases in
the United States due to high vaccination rates: Sandra W. Roush, Trudy V. Murphy, and the
 3

Vaccine-Preventable Disease Table Working Group, Historical Comparisons of Morbidity and

Mortality for Vaccine-Preventable Diseases in the United States, 298:18 Journal of the
American Medical Association 2155-63(Nov. 14, 2007),
http://jama.jamanetwork.com/article.aspx?articleid=209448

 More on how “herd immunity” has been accomplished: This is another technical article
offering a historical explanation of how the process of vaccinating the general population
and surveilling vaccination coverage has developed in the United States. Philip J. Smith,
David Wood, & Paul M. Darden, Highlights of Historical Events Leading to National
Surveillance of Vaccination Coverage in the United States, 126 (Suppl 2) Public Health Rep. 3-
12 (2011), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113425/

(4) Post in the Discussion Forum. Based on your experience playing the Vax game and reading all
this information about vaccinations and herd immunity, do you think that state governments
should take steps to increase measles vaccination rates? If so, what should they do? And why?