Opening Vaccine Dialogue Across Cultures: Measles Outbreak in Minnesota

By: Nusheen Ameenuddin, MD, MPH, FAAP

To recognize National Immunization Awareness Month (NIAM), Speak Now for Kids will be sharing articles on kids and immunizations from the American Academy of Pediatrics. You can learn more about immunizations by visiting HealthyChildren.org.

“Most of you already know Dr. Nusheen, because she sees your kids” is how I was introduced on my home turf at the first of a series of talks with Minnesota’s Somali community.  It was during our state’s worst measles outbreak to date.

By the week before Memorial Day this year, Minnesota had already reached 69 measles cases, more than all U.S. cases in the previous year. Because the outbreak primarily affected unvaccinated Somali children, our state health department, American Academy of Pediatrics chapter and others partnered with leaders in the Somali community to train and dispatch teams of imams (religious leaders) and physicians to engage and inform the community about this threat.

I feel privileged to work with a vibrant patient population that includes many Somali-Americans. I met some families as new arrivals to this country, while others have become my second generation of patients. We are fortunate that Minnesota’s children’s health insurance coverage is at an all-time high of 97 percent, thanks to Medicaid and CHIP. But despite having some of the best health measures in the nation, we still struggle with the highest disparity in health outcomes between ethnic groups.

One particular area of concern centered around vaccination rates. In 2004, the MMR immunization rate for Somali children in Minnesota was 92 percent, higher than that of non-Somalis (88 percent). But due in large part to a targeted effort by anti-vaccination groups, MMR vaccination rates dropped dramatically, to 42 percent, over a decade.

Knowing that I would have to counter entrenched vaccine myths, I prepared for my first talk by reviewing pseudoscientific claims on anti-vaccine websites. But years of discussions with vaccine-hesitant parents of all backgrounds had taught me that facts alone would not convince skeptics, particularly when fear was involved.

Taking a page from the 2016 AAP Clinical Report Countering Vaccine Hesitancy, I knew that this dialogue was meant to be ongoing. It was my job to address parents' concerns and explain the science, extraordinarily rigorous safety testing and continuous monitoring behind vaccines that most people outside the field of pediatrics do not know. Sharing how parents of hospitalized measles patients heard their children gasping for air, feeling helpless to intervene, also reinforced how dangerous this disease was--even with modern medicine to assist.

Nusheen Ameenuddin, MD, MPH, FAAP, vice-chairperson of the American Academy of Pediatrics Council on Communications and Media executive committee, practices community pediatrics and adolescent medicine at the Mayo Clinic in Rochester, Minnesota. She also serves on the Board of Directors for the Minnesota Chapter of the AAP.

To read more about Dr. Ameenuddin’s experience with working in the Somalia population click here