A measles epidemic near Portland, Oregon, reopened heated debate over so-called "philosophical" exemptions from childhood vaccinations in public health North West Pacific officials are struggling to limit the fallout.

At least 44 people in Washington and Oregon have become ill in recent weeks with the highly contagious virus, which was eradicated in the United States in 2000 as a result of vaccination, but which periodically arrives with travelers from other countries. -sea. More than half a dozen more cases are suspected, and people exposed to the disease have traveled to Hawaii and Bend, Oregon, which could raise fears of more diagnoses in unvaccinated people .

Washington Governor Jay Inslee last week declared a state of emergency because of the epidemic.

"I hope this will end soon, but it could take weeks or even months," said Dr. Alan Melnick, Clark County Public Health Director, in Washington State, just north of Portland. The county has had most cases diagnosed so far. "

Of the confirmed cases, 37 are people who have not been immunized. Most of the confirmed cases were children under 10 years old. The authorities said that one case was a person who had received a dose of measles vaccine.

"The measles vaccine is not perfect, but a dose is 93% effective at preventing disease," Melnick said. "The two recommended doses of measles vaccine provide even greater protection – 97%."

Washington state legislators have reviewed the non-medical exemptions allowing children to go to school without being vaccinated if their parents or guardians express a personal objection. The liberal-minded US and Oregon have some of the highest vaccine exemption rates in the country, due in part to low immunization rates in dispersed communities and some private and alternative schools.

Four percent of high school students in Washington benefit from a non-medical vaccine exemption. In Oregon, where a similar law is in effect, 7.5% of kindergarten children in 2018 were shot and wounded for non-medical reasons.

Washington and Oregon are among 17 states that allow a type of non-medical exemption for vaccines for "personal, moral or other beliefs," according to the National Conference of State Legislatures.

Many studies have shown that vaccines do not cause autism – a common reason cited by those who do not want their children to be vaccinated. Opponents of certain vaccines also oppose what an outside authority orders what they put in their children's bodies. Some fear that measles vaccine is associated with mumps and rubella vaccines, as is usually the case.

A measure introduced by Republican Representative Paul Harris of Vancouver, Washington – the epicenter of the current outbreak – would remove the personal exemption specifically for the combined measles, mumps, and measles vaccine. rubella, or the MMR vaccine. A public hearing is scheduled for Olympia on February 8th.

Democratic representative Monica Stonier of Vancouver, co-sponsor of the bill, said she would prefer an even broader proposal, but "for the moment, we are looking at what can move us." Previous attempts failed.

"We are trying to address a very specific concern here and recognize that there may be broader concerns that we can consider in the future," Stonier said.

Oregon has the highest vaccine exemption rates in the country, and some communities have even higher rates. The Washington exemption rate, while lower, is also high compared to other states. Nationally, the median exemption rate of at least one vaccine among children entering kindergarten in 2017-18 was just over 2%.

Senator Elizabeth Steiner Hayward, Democrat and Family Physician, in the state of Oregon, waived an attempt to revoke the state's non-medical exemption in 2015 after a virulent opposition. The Legislative Assembly now requires parents to watch an educational video or speak to a physician before applying for the exemption.

In Washington State, a bill that would have removed the allowance of personal or philosophical conviction never went to the House for a vote in 2015, despite strong opposition.

The National Vaccine Information Center, which opposes mandatory vaccination laws, has said it is opposed to this bill and the current project. Another anti-vaccination group, Informed Choice Washington, had its members in the House of Representatives Thursday to try to dissuade lawmakers.

"People feel extremely oppressed and feel unable to make an informed decision," said Barbara Loe Fisher, co-founder and president of the group. She said the legislation "slams the hammer and threatens people instead of allowing them to make informed decisions".

California is one of the few states to have removed personal-use vaccine exemptions for children in public and private schools. The law passed in 2015 after a measles outbreak at Disneyland sickened 147 people and spread to the United States and Canada. This was despite an earlier law that required parents to talk to a doctor to withdraw vaccines. Vermont also dropped its personal exemption in 2015.

Senator Richard Pan of the State of California, a pediatrician who sponsored his state's bill, said he had received death threats against him and that advocates of vaccination had blocked his phone lines and harassed him on social media.

The overall vaccination rate for children entering kindergarten in California reached 95% in the two years following the adoption of the law. Parents who do not want to vaccinate their children can go to school at home or enroll their children in independent studies at the local public school.

Measles remains a serious problem in other parts of the world, and travelers infected abroad can bring back the virus, causing periodic outbreaks.

Last year, there were 17 outbreaks and about 350 cases in the United States. Before mass immunization, every year 400 to 500 people in the United States died of measles. Serious complications include swelling of the brain that can cause blindness or deafness and pneumonia.

The first symptoms include a fever, a runny nose and discomfort, followed by a rash that starts around the head and moves along the body. Patients are contagious four days before and four days after the onset of rash.

Nine out of 10 unvaccinated people exposed will have the disease. A non-immune person may become ill up to three weeks after being exposed to the virus.

Rachel La Corte, Associate Press Writer at Olympia, contributed to this report.

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