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Measles continues to spread around the country. The Centers for Disease Control and Prevention says 888 cases have been confirmed across 24 states. The outbreak has raised questions about why some children don't get vaccinated. There are religious and ideological reasons. But there's something else, too - poverty and access to health care. NPR's Selena Simmons-Duffin has the story.
(SOUNDBITE OF KNOCKING ON DOOR)
MELANIE SIEFMAN: Hi, are you guys ready?
SELENA SIMMONS-DUFFIN, BYLINE: The 2-year-old looking up at pediatrician Melanie Siefman at Unity Health Care in Washington, D.C., seems a little dazed.
SIEFMAN: You OK, my dear?
SIMMONS-DUFFIN: Could be because she just woke up from a nap. Or...
SIEFMAN: Does she know it's coming?
SIMMONS-DUFFIN: Yeah, her mom says she remembers the shots from last time.
SIEFMAN: All right, so it looks like vaccine-wise she is just missing one DTaP and one polio vaccine.
SIMMONS-DUFFIN: The little girl's catching up. She's 2, but those shots are scheduled for a baby's 6-month appointment.
SIEFMAN: It happens a lot that patients miss several different visits. A lot of times they weren't able to get in for various reasons - transportation, couldn't get off of work, didn't have insurance.
SIMMONS-DUFFIN: The clinic where Siefman practices serves mostly low-income, mostly African American patients. She does see patients whose parents are vaccine hesitant - they don't trust vaccines - but she says that's rare.
SIEFMAN: Luckily, knock on wood, we have not had a measles outbreak in D.C. And I hope that we don't. But I think here, based on my population, it would be more because of just inadequate vaccination because they're just not coming in and not because of the anti-vaccine group - just because I don't see so many of those kids.
SIMMONS-DUFFIN: There is a risk of measles here. The measles vaccination rate in D.C. for kindergartners is only 81%, the lowest of all the states.
HOLLY HILL: Definitely lower than we'd like to see, absolutely.
SIMMONS-DUFFIN: Dr. Holly Hill is a medical officer at the CDC.
HILL: We really look for, at very least, 90% percent - hopefully more like 95% in order to prevent outbreaks, especially with measles because it's so infectious.
SIMMONS-DUFFIN: Hill says nationally, the connection between poverty and vaccination rates bears out.
HILL: We see large coverage gaps among children who are living below the poverty line compared to those at or above poverty and among children who have no insurance. For some vaccines, they're up to 20 to 30 percentage points lower than kids who have private insurance.
SIMMONS-DUFFIN: Insurance isn't supposed to be a barrier. There's been a federally funded program since the '90s, called Vaccines for Children, that provides free vaccination to children who are uninsured or on Medicaid. She says it's not clear why that program isn't reaching more kids.
HILL: Is it more important to try to make sure that uninsured kids get onto Medicaid or some other insurance? Or do we need to have services that are more convenient for people living under the poverty level, who might not be able to travel long distance to take a child to a doctor or may not have time off from work?
SIMMONS-DUFFIN: She says each state will need to tailor these responses to their particular populations. In D.C., that local outreach is part of Dr. Anjuli Talwalker's job at the department of health.
ANJULI TALWALKER: We recently sent a letter to principals specifically about measles, you know, continue to have messaging on our website and through social media.
SIMMONS-DUFFIN: She says they are on alert for measles. There have been cases in neighboring Maryland. And as the nation's capital, there are visitors from all over all the time. Now they're focusing on using schools to tell families about measles in these last few weeks before summer vacation and relying on doctors.
TALWALKER: Even if a child goes to the doctor not for their vaccine, you take that as an opportunity to vaccinate.
SIMMONS-DUFFIN: Dr. Melanie Siefman at Unity Health is on that.
SIEFMAN: OK, so tell me about what is bringing you guys in for the first place.
SIMMONS-DUFFIN: An 11-year-old patient came in because a new pet was causing allergies.
SIEFMAN: ...Things like changing clothes.
UNIDENTIFIED PATIENT: OK.
SIEFMAN: OK? All right, now let's talk about vaccines. I know that wasn't why you came in, so I'm sorry, my dear.
SIMMONS-DUFFIN: The patient ended up getting three vaccines to stay up-to-date. Selena Simmons-Duffin, NPR News.
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