Kate Hoerster’s daughter was only 6 months old when Washington declared a state of emergency after a measles outbreak in January. Hoerster, 40, lives with her husband and two children in Seattle, and most of the measles cases and exposures were in Vancouver, a city about 2.5 hours away.
Still, Hoerster was worried about how to keep her baby safe from the potentially fatal virus, while also maintaining her toddler’s very active social life.
Once measles was confirmed in King County, Hoerster chatted with a pediatrician friend and came up with an interesting, if awkward, way to keep her daughter safe until she could get her first MMR shot at 12 months.
After scheduling each play date for her 2-year-old son, Hoerster would follow up with a short text message to the parents.
It explained that, during the outbreak, Hoerster and her husband were choosing to limit their exposure to unvaccinated people while their daughter was still an infant.
“I ended up using text versus other means because it felt a little less invasive,” Hoerster said. “So people would have time to think about how they would want to respond, including if they weren’t vaccinated and wanted to find an alternative explanation for why they couldn’t hang out.”
Each family has its own set of rules for raising children, and parents are generally loathe to be seen as "judging" the decisions of others. But during disease outbreaks, some families in high risk areas are making difficult decisions to limit who they socialize with in order to protect their young children from potentially serious infections.
There are ongoing measles outbreaks in New York, Washington, California and New Jersey, according to the Centers for Disease Control and Prevention. As of April 11, there were 555 cases of measles confirmed in 20 states, the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000.
Experts say there’s a good reason for parents’ fear. Measles is a highly contagious airborne respiratory virus that can survive in the air for up to two hours. It’s also not immediately obvious that people who are sick are actually infected with the measles. They can be contagious up to four days before and four days after the tell-tale rash appears.
Noelle Williams is a 32-year-old mother who lives in Brooklyn, home to most of the hundreds of measles cases confirmed since October. Her 15-month-old daughter received her first MMR shot before New York City declared a public health emergency on April 9, so she doesn’t feel the need to screen her daughter’s play dates.
Williams often takes her daughter to the Brooklyn Children’s Museum, which is located near the neighborhoods most affected by the outbreak, and wonders what she would do if her daughter wasn’t vaccinated.
“My daughter was there last weekend and hugging other children she just met, and I thought to myself, ‘This would terrify me if she wasn't vaccinated,’” Williams told TODAY.
Do you want to ostracize certain children because of choices their parents have made?
How parents address the vaccine question with other families during an outbreak depends on many different factors, including the age of their child and the severity of the outbreak, said Dr. Sean O’Leary, a spokesman for the American Academy of Pediatrics and an associate professor of pediatrics at the University of Colorado Anschutz Medical Campus.
A child is generally around 4 or 5 years old by the time they get two shots of the MMR vaccine, which together are 97 percent effective against the measles virus. This means parents with older children who are fully vaccinated may not need to worry as much as the parent of an infant, or the parent of a child with a suppressed immune system who can’t get vaccinated.
Much like Hoerster’s approach, O’Leary, who is also a parent, said he would “politely decline” get-togethers with non-vaccinating families during a measles outbreak. But only if he had a baby who was too young to get the MMR shot.
Still, he said the question remains a difficult one to offer a firm recommendation on.
“You also have to think about the children in this context,” said O’Leary. “Do you want to ostracize certain children because of choices their parents have made?”
In the absence of any official recommendations from the American Academy of Pediatrics or other medical groups, parents are weighing the risks and benefits of potential disease exposure on their own.
For the families who choose not to vaccinate their children, disease outbreaks can spur a change of heart. In Rockland County, New York, where officials have confirmed 184 measles cases, health workers have given over 18,000 MMR shots since the outbreak began in October.
'Better than the alternative'
Five years ago, Alisson, a 41-year-old mother of two, was on maternity leave with her second child when Washington had a different measles scare in 2014. Alisson, who requested her last name not be used, lived in Bellingham when a person with the virus exposed potentially thousands of people to the illness in Lynden, a town 30 minutes away.
Her husband, a physician, asked her to consider staying home until the risk was declared over. She agreed with the decision, but was angry about it for a long time.
“It was so frustrating to lose two weeks of my life sitting at home,” she recalled. “But it was better than the alternative — continuing to live my life and lose my child because he got measles and died from it.”
Brooke Fotheringham, a 43-year-old mom of two boys ages 6 and 9, also lives in Seattle. Because her children are older and fully immunized against MMR and other diseases, she doesn’t feel the need to screen her sons’ friends or broach the topic with their parents.
But she did find herself taking more precautions during her state’s most recent measles outbreak.
“We tended to meet at the park during the measles outbreak,” she said. “I was less inclined to meet them in an enclosed space somewhere if they weren’t vaccinated.”