Any outbreak of measles is cause for concern, but the current outbreak in Minneapolis, Minnesota stands out for two reasons. One, almost none of the victims were vaccinated against the disease. Two, nearly all of the victims are ethnic Somalis.
Doctors say the situation is the result of the disproven, but persistent, belief the vaccine for measles, mumps and rubella (MMR) can cause a child to develop autism.
Dr. Mohamed Hagi Aden, an internal medicine specialist at Regions Hospital in neighboring St. Paul, says more than 50 percent of Somali-American children in the area never get the MMR vaccine, due to autism fears.
The result is seen in the measles outbreak statistics. As of Tuesday, the Minnesota Department of Health had recorded 50 cases of measles in the state. It said 45 of those infected were confirmed to be unvaccinated against measles, and 45 of the cases were Minnesotan Somalis (or Somali Minnesotans, as the department put it).
Dr. Aden says opposition to the MMR vaccine stems from a perceived high rate of autism within the local Somali-American community. A report by the University of Minnesota showed that in 2010, about one in 32 Somali children in Minneapolis between the ages of 7 and 9 was identified as having autism spectrum disorder (ASD).
"And while parents were looking for answer, they found a study by a British researcher that linked the autism and the MMR vaccine, and that has created fear and suspicion with the community,” Dr. Aden told VOA's Somali Service.
The study he cites is real; it was published in the British medical journal The Lancet in 1998. But the journal retracted the finding 12 years later, saying it contained errors.
In the meantime, multiple studies have failed to find any evidence to back up the original study's claims. One study of 95,000 American children found "no harmful association between MMR vaccine receipt and ASD," even in cases where kids' older siblings had been diagnosed with autism.
"There is no link between the MMR vaccine and autism,” says Dr. Aden.
Making the case for vaccination
As the outbreak grows, the Minnesota Department of Health is working to win back trust in vaccines.
It's harder than it used to be, says the department's infectious disease director, Kris Ehresmann.
"You used to be able to get up and say, 'I'm a scientist and X percent of people did Y, and everyone said, 'Oh yes, OK, we need to change our behavior,'" she said. Now, she says, "It's a different world."
And in the case of the Somali-American community, where a large number of people are immigrants and refugees who are less assimilated, "It's more of getting the community to own the issue and own the solutions."
That means a lot more community outreach. In the past few years, the Department of Health has hired two Somali outreach workers. One visits mothers' groups, day care centers and charter schools to talk about vaccines.
Another Somali worker talks to parents about autism and the resources available for special-needs children.
"The community does have very real concerns about autism," Ehresmann said. "By saying, 'Oh, vaccines don't cause autism,' that's not sufficient."
Some of the most important voices advocating for vaccines have been Somali doctors and other health professionals, and the imams from the hardest-hit areas, Ehresmann said.
"These folks are really stepping up to the plate and speaking out on the value of vaccines on their own. It is coming from within the community leadership. That is really important," she said.