Health & Science

How Houston Doctors Are Responding To A Record Rise In Measles

Some parts of the Houston area have higher rates of unvaccinated children, putting pediatricians in a challenging position.

A vaccine vial.

With more parents refusing to vaccinate their children, Houston pediatricians are reconsidering policies at their clinics, including refusing to treat patients whose parents won’t vaccinate them.

In Texas, there were 15 confirmed cases of measles in the first three months of 2019 — more cases than all of last year. And one-third of the Texas cases this year were in the Houston area. 

Dr. Melanie Mouzoon, who oversees immunization practices across Kelsey-Seybold Clinic’s 20 Houston locations, said their clinic in The Woodlands has more families that refuse vaccinations than the other locations.

“There have been some practices in town that have decided to not accept families that do not vaccinate their children,” Mouzoon said. “And we’ve had an influx of vaccine hesitant families, and so that’s been something that our system is struggling to deal with.”

At Kelsey-Seybold, individual practices decide whether to refuse to treat a family.

The Texas Children’s Hospital system uses a similar approach. Jenn Jacome, a spokesperson with Texas Children’s, said in a statement their position is that “unvaccinated children may pose a risk to some individuals who come to our practice sites.” That’s why “each TCP practice determines whether or not to accept patients whose parents refuse to vaccinate.”

For Kelsey-Seybold, Mouzoon said there’s a growing demand for a system-wide protocol.

“I think we are likely to put in place a policy or at least put in place a brochure or something to give parents that explains our position,” Mouzoon said. “That also will give us some backup support in terms of eventually dismissing a family if it comes to that, if the trust is lost.”

Two decades ago, doctors across the country were discouraged from dismissing families. That has changed in recent years. Rekha Lakshmanan with the Houston-based Immunization Partnership said that it’s out of concern for their other patients.

“I mean you’ve got newborns coming in,” Lakshmanan said. “If you have an active case of an infectious disease in your waiting room, it puts that newborn and others at risk. A decision has to be made by that physician, ‘Okay what am I going to do?’”

Some people say it’s enough to separate patients into two separate waiting areas, one for sick children and one for well children. However, Mouzoon said that’s not a sufficient protection for many children because measles can stay in the air for two hours after an infected individual has left the clinic. In addition, air circulation can spread measles.

“Measles is something that children are not vaccinated against until they’re a year old, so it’s not that parents are negligent in that case,” she said. “Their children are too young for that vaccine, and so we have to do something to protect those families.”

Improving transparency

Another strategy doctors are turning towards is making more information available to parents. Currently, in Texas, parents can’t find out how many kids are unvaccinated at their school. School nurses collect that exemption data, but it’s reported only on a district level. And that’s not always helpful for parents or public health officials.

“It’s not the overall county rate that really matters,” Mouzoon said. “What really matters is the rate in your kids’ school.”

There’s a push in the Texas legislature to change that. Gatesville Republican Rep. J.D. Sheffield, who is a family physician, is proposing a transparency bill that would make that information public. The Immunization Partnership recently held a rally along with 300 attendees at the state capitol to support the bill.

Lakshmanan said that data would likely reveal some schools have exemption rates well beyond the five percent threshold that doctors consider safe.

“It wouldn’t surprise me,” Lakshmanan said. “In the data that are publicly available there are some schools that have close to 50 percent exemption rates. These are a couple of private schools in the Austin area. It’s in the high 40s. It is not safe, no.”

She said unimmunized kids tend to cluster in particular schools. Mouzoon has seen this a lot in educated, wealthy neighborhoods.

“We know vaccine hesitancy is high in the River Oaks/Tanglewood area and in the Woodlands,” Mouzoon said. “Kingwood also has some hesitancy. And really that’s because parents get together and talk and they share their concerns so fear spreads, panic spreads, hesitancy spreads.”

Some doctors are worried policies won’t change unless things get worse. Dr. Peter Hotez is Dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development.

“Eventually, this whole problem will autocorrect, but it will autocorrect at the expense of children,” Hotez said. “It will autocorrect because of a horrific measles outbreak like the one that happened in California.”

After that outbreak in 2015, in which 147 cases were reported, California banned non-medical exemptions. Without legislative solutions, Hotez said doctors have limited options.

“It’s become so pervasive now that I think we’re seeing a certain amount of frustration setting in,” Hotez said. “I think pediatricians are wondering what else to do at this point.”

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