As measles cases spread, Taos ‘ripe for an outbreak’

Taos County vaccine rates among lowest in state, records sparse

By Cody Hooks
Posted 6/11/19

Measles is preventable with vaccines, yet the highly contagious disease has made a dramatic resurgence so far in 2019.

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As measles cases spread, Taos ‘ripe for an outbreak’

Taos County vaccine rates among lowest in state, records sparse


When the United States officially declared measles eradicated back in 2000, it was a major public health victory.

The disease can cause more than the cough, rash or fever that first set in. Complications can land a person in the hospital with conditions ranging from pneumonia to brain swelling. One or two people out of every 1,000 infected with measles will die from it.

Measles is preventable with vaccines, yet the highly contagious disease has made a dramatic resurgence so far in 2019.

Nearly 900 cases have been reported in about half of the country. While New York state has the biggest concentration of measles, Colorado, Arizona and Texas all have confirmed cases of the disease. New Mexico joined that list last week, when the New Mexico Department of Health confirmed a case of measles in Sierra County.

The spread of measles has doctors and health care professionals across the United States worried that their communities could be next.

Especially in Taos.

“The fact is, we are vulnerable to vaccine-preventable diseases,” said Dr. Alana Benjamin, a medical doctor at Taos Whole Health Integrative Care.

The Centers for Disease Control recommends that kids get their first dose of the measles vaccine by the time they’re 15 months old, and the second dose by the time they’re 4 years old. But as Taos County proves, that’s not happening.

Benjamin notes that, according to her review of public health data, only 43 percent of Taos County kids between the ages of 18 and 36 months are vaccinated against measles.

That means more than half of an especially vulnerable population is without protection from the disease.

“We are ripe for an outbreak,” Benjamin said. “It’s only a matter of time before it spreads here.”

The conversation

In clinics throughout town, the conversation with parents about vaccines comes up frequently, whether it’s in the public health office or one of the family medicine practices like Benjamin’s office or Schreiber Family Medicine. Physicians take different approaches to the conversation, but all steering the conversation back to the importance of vaccines.

Before Benjamin moved to Taos, vaccines weren’t a major part of her medical practice. Most people in those other communities vaccinated their kids on schedule, she said, so it wasn’t a big deal during well-child visits.

But since starting to practice in Taos five years ago, the vaccine talk seems unending.

“I run into this issue daily,” she said.

It’s her approach genuinely to listen while also pressing the importance of vaccines.

“I’m a medical doctor and I really do believe in vaccines. I think they are one of the most important public health developments in [the last] century. It’s part of why we live as long as we do, and it’s part of why children don’t die anymore from a lot of these preventable disease,” she said.

The CDC recommends that kids in 2019 receive more vaccines than in the past — 14 in total, for diseases like measles, whooping cough, polio and hepatitis. At the same time, the contents of immunizations have improved; mercury hasn’t been used in childhood vaccines since 2001, and the number of “immunological components,” the weakened form of the disease that creates immunity, has been sharply reduced.

“That being said, I know there are a lot of people in this community that have different views about it. I want them to have a place where they can at least express their concerns. I try to gently correct on scientific misinformation, but then establish an open, comfortable environment,” Benjamin said.

Parents tend to worry, she said, about aluminum, which is added to vaccines to make them more effective, or about doubling up on vaccines during regular doctor visits. However, perhaps the foremost concern among people skeptical of vaccinations is autism.

This is where Dr. Lucas Schreiber tends to start.

“This is a very difficult dilemma that I face on a daily basis. The anti-vaccine movement has become increasingly vocal,” Schreiber said. He recounts the root of the movement, an infamous but discredited study that “suggested a link between the measles, mumps and rubella [MMR] vaccine and autism.”

The study’s author, Dr. Andrew Wakefield, “was ultimately found guilty by the General Medical Council of dishonesty and flouting ethics protocols. Unfortunately, his study ... created international skepticism of immunizations.”

After that, Schreiber hones in on the “true and now present danger of the diseases the vaccines are designed to prevent.”

With measles alone, Schreiber says, “four million children acquired measles annually and up to 3,000 died of measles each year in this country.”

“There’s some real consequences” of not getting vaccinated, said Judith Pierce, nurse manager at the Taos Public Health Office, which administers vaccines for free to people who don’t get them at a regular doctors office. “We don’t want there to be any barriers.”

But public health campaigns require years-long tactics.

“The biggest thing is building up the trust,” said Benjamin. “I have had a lot of parents who initially weren’t going to vaccinate, or weren’t going to for a while. But over time, they trust me as a doctor and trust what I’m telling them, and they have come in for vaccines. [It’s] because we developed that relationship.”

The numbers

In early March, as measles outbreaks were popping up around the country, the Department of Health aired a worrying trend in the state’s vaccination rates.

“Over the last seven years, New Mexico has seen a steady increase in the number of children who are not fully vaccinated. Since 2012 in New Mexico, there has been a 60 percent increase in the rate of people exempting from recommended vaccinations,” it read.

Under New Mexico law, kids can only be exempt from vaccines for two reasons: medical, which requires a doctor’s note, and religious. Personal, political or philosophical disagreements with vaccines aren’t grounds for an official exemption.

Taos County has consistently been the county with the highest rates of kids exempted from vaccines.

In 2015, 4.6 percent of Taos County children between the ages of 4 and 18 were exempted from vaccines. Santa Fe County came in second, with 3.7 percent, and Los Alamos County with 2.7 percent, according to the state health department.

That ranking has largely stayed the same, though Taos County now stands at 3.2 percent, and Santa Fe and Los Alamos counties at 2.9 and 2.6 percent, respectively.

A 2015 document posted to the DOH website shows that among school districts with more than 600 students, Taos ranked third for the percent of students with exemptions — 2 percent, compared to 2.1 percent in Santa Fe County and 2.3 in and Los Alamos County.

Taos School District Director of Exceptional Programs Lynn Brashar said that data, though it’s now four years old, was encouraging, because the school district had a higher vaccination rate than the county overall.

But even though doctors’ offices, the public health clinic and school districts upload vaccination information into a central state-run database, a more current and detailed picture of vaccination rates, especially in schools, is hard to come by.

David Morgan, a communications manager at the New Mexico Department of Health, said via email the DOH did not have vaccination rates for individual schools or districts. “I have confirmed [the Public Education Department] does not track anything related to vaccination exemptions at all,” he said. Indeed, the DOH said it was working with the PED “to improve vaccine record-keeping in schools.”

The “best bet” for more detailed data about the vaccination rates in schools, he said, “is to contact the individual school districts and charter schools.”

The Taos News made initial inquiries to the Taos Municipal School district about vaccine and vaccine exemption data in early April.

On Thursday (May 16), Taos Superintendent Lillian Torrez said that in the district’s five traditional schools and three charter schools, 50 students were exempt from vaccinations.

Across the district, Taos High School has only three exempted students, Taos Middle School has two exempted students, Enos Garcia Elementary School has 10 exempted students and Ranchos Elementary has five exempted students. Among the district charter schools, Vista Grande has three exempted students. No specific number of exempted students were provided by either the district or directors of Taos Charter School or Anansi Charter School

Taos district officials did not share the number of parents who are delinquent on reporting state-mandated vaccination information to the district.

The dangers

Even if a more nuanced vaccination picture is obscured, one thing isn’t: Taos lacks a high enough vaccination rate to protect the most vulnerable people in the community — including very young children who haven’t been vaccinated — from highly contagious diseases.

Some diseases, such as measles, can spread like wildfire in places with low vaccination rates. If an infected person coughs, for example, the measles germ can linger in the air for hours. It’s so contagious that if 10 unvaccinated people come into contact with the germ, up to 9 of them will get measles, according to the CDC.

But vaccines don’t just protect a person who is immunized.

If enough people in a community are vaccinated, then the community could have “herd immunity,” where even unvaccinated people, like babies who are too young for it or people with immune disorders, are somewhat protected from the disease. Herd immunity works because the germ keeps hitting roadblocks — that is, immunized people — meaning it won’t spread as quickly.

But a lot of people have to be vaccinated for herd immunity to work.

For measles, herd immunity kicks in when around 90 to 95 percent of the population has received the MMR vaccine. Herd immunity for less contagious diseases still require a vaccination rate between 80 and 85 percent.

“Our vaccination rates are not above the threshold we need for herd immunity,” said Benjamin.

She said that when parents bring their kids into her clinic, she’s open about the fact that she vaccinates her kids, for their protection and for that of the community.

“I don’t enjoy injecting a needle into my baby, of course, but I feel like it’s necessary for public health,” she said.

“I think people think they’re just protecting their kid, and they don’t necessarily understand their choice to vaccinate or not to vaccinate actually does have a big impact on the health of the community,” she said. “I bring it up but it’s a tough conversation to have with a parent in the exam room without making them feel guilty.” 

So she practices persistence, asking parents during each visit if they’re ready to vaccinate their kids.

And in the meantime, health care professionals are prepping for what to do in the event of an outbreak locally.

“If we see a local outbreak of measles, the community physicians will work closely with the New Mexico Department of Health to identify and track the index case and to isolate ill or exposed patients,” said Schreiber.

Indeed, Pierce, the nurse manager at the local public health office, said that in the event of an outbreak, her office would take guidance from the state epidemiologist to try to contain the outbreak.

“We’d get that support,” Pierce said.

“We’re ready, as ready as we can be,” she said.


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