The religious exemption from Hawaii law requiring children who attend a childcare facility or preschool, public or private school to be immunized against measles has been suspended — effective immediately — by Hawaii Gov. Josh Green, as an emergency measure. This is a necessary and laudable step to protect Hawaii’s vulnerable children and adults, including those who can’t be vaccinated for medical reasons, from a spectacularly infectious virus that can cause serious illness and even death.
The rule doesn’t mandate vaccinations — but students who aren’t vaccinated against measles because of a religious exemption must stay out of and away from schools, preschools or childcare operations unless or until they get immunized. That’s because measles is the most contagious human virus known to exist, and unvaccinated people are the ones likely to catch it and spread it.
The emergency order comes on the heels of Tuesday’s announcement that the first confirmed case of travel-related measles has appeared in Hawaii this year. An unvaccinated child under age 5 was found to have measles after returning from an international trip, and an unvaccinated adult traveling with the child had similar symptoms.
The proper course now for all unvaccinated people in Hawaii is to obtain a measles, mumps and rubella (MMR) vaccine — for self-protection, and to protect other people who could be harmed should measles spread. Green frames the option in a positive light, stating, “The rules allow children with religious exemptions to receive the MMR vaccine while still retaining their exemption to other vaccines and staying in school.”
Meanwhile, measles infections are surging on the mainland in communities that shun vaccinations — often for religious reasons. More than 600 have been confirmed infected, and two children have died.
The measles virus can remain alive for up to two hours, floating through the air or contaminating a surface when an infected person coughs or sneezes. If an unvaccinated person is exposed to a person with measles, the chances are about 9 in 10 that they will get measles, too. Unvaccinated people can be exposed by breathing the air where a person with measles has been — even if they’ve already left — or touching their eyes, nose or mouth after having touched a contaminated surface.
When a contagious person with measles is around a group of unvaccinated people, an average of 18 will contract the disease. Those 18 may each infect another 18 — a total of 324 people. And that’s how fast measles can spread in an unvaccinated population.
A person with measles is contagious for about three days before showing signs of infection — typically a cough, runny nose, red, watery eyes and fever. It can be three to five days before a tell-tale, blotchy measles rash appears, first on the face, then potentially from head to toe.
In severe cases that are more likely to afflict children under 5, measles can cause pneumonia, encephalitis and brain damage, or severe diarrhea and dehydration, all of which can be deadly, as well as blindness. Unvaccinated, pregnant women also face higher risk of serious complications, miscarriage or premature birth.
Thankfully, the unvaccinated child with measles is recovering at home. The risk to others, however, remains. Because measles is so contagious, vulnerability rises when vaccination levels fall below 95%, as they have in many communities here. Statewide, Hawaii’s MMR vaccination rate is 89.8% — and some schools have dangerously low coverage, especially on the neighbor islands.
The best protection is vaccination. In fact, two doses of the MMR vaccine — recommended since 1989 — have been proven 97% effective. To prevent unnecessary infection, or worse, all who physically can must now do their part, and get those measles shots.
