He was 13 years old and playing in a barn in rural Kansas City when he accidentally scraped himself on a rusty nail. A few days later, he was too weak to walk and began having the excruciating muscle spasms that come with contracting tetanus.
Christelle Ilboudo, a pediatrician and pediatric infectious diseases expert at MU Health Care, distinctly remembers the day the boy's family brought him in to be evaluated.
At first the family thought it was just a virus of some kind. His whole body was stiff, and he had a fever. They finally decided to make him an appointment one morning when he tried walking to their bedroom and collapsed to the floor, Ilboudo explained.
The boy hadn't been vaccinated, the Columbia Missourian reported.
"He luckily survived, but one vaccination could have prevented that — like so many other diseases we are beginning to see again," Ilboudo said.
The reappearance in the U.S. of diseases that were once thought to be eradicated, specifically, measles, has prompted national alarm and calls for more action by the federal government to urge vaccination.
On March 13, a measles case was confirmed in eastern Missouri due to out-of-state exposure. It was not confirmed whether the person had been vaccinated.
The World Health Organization announced vaccine hesitancy as one of the 10 threats to global health in 2019. The organization identified complacency, inconvenience in accessing vaccines and lack of confidence as key reasons underlying hesitancy.
According to the United Health Foundation, Missouri ranked 21st alongside Alabama for vaccination rates of children ages 19 months to just under age 3. This is the age range when the measles, mumps and rubella vaccination is first administered.
Among the recommended vaccinations is the MMR vaccine, which protects against the three viral diseases. They typically affect younger children and can be dangerous due to how fast they spread.
Measles can be identified by a pinpoint rash, and if not treated, can lead to pneumonia, brain inflammation, seizures and permanent brain damage, according to the Centers for Disease Control and Prevention.
In data collected by the CDC, there has been an annual increase in measles cases. Last year, 15 states, Missouri included, reported a total of 372 measles cases. As of March 14, the same states reported 268 cases.
The CDC also reported that a majority of the 2018 cases came from international travel. That year had the greatest number of imported cases since measles was eliminated from the U.S. in 2000.
Although more cases are being reported nationwide, states are taking stances that vary across the board.
In Missouri, two bills were introduced this year that would eliminate the religious belief exemption and allow minors to consent to vaccinations. In response, another two bills were introduced in opposition that would prohibit discrimination against children who are not vaccinated in medical settings and require medical practitioners to provide informational paperwork to parents prior to vaccination.
All 50 states allow some K-12 medical vaccination exemptions; 47 states allow religious exemptions; and 17 states allow personal belief exemptions. Missouri allows both medical and religious exemptions but not personal belief exemptions for K-12. However, Missouri law does allow a parental exemption at any preschool, day care or nursery school if the parent or guardian files a written objection with the day care administrator.
In the 17 states that allow for personal belief exemptions, it can be as simple as a box check for parents.
Meanwhile, measles outbreaks are increasing among unvaccinated children, specifically in Washington and Texas. These are two of 17 states that allow for personal belief exemptions.
In late February, an Arizona legislative panel voted to expand its exemption list, making it easier for parents to opt out.
In an interview with NPR, Jessica Rigler, branch chief of public health preparedness at Arizona's department of health services, said more than 5,000 kindergartners in the state could fall sick with measles if there were an outbreak.
There is also new, additional evidence that parents' fear of vaccine safety is unfounded.
The results of a 10-year Danish study of 10,000 children, released on March 5, validated the results of a 2002 study that found no relationship between MMR vaccination and autism. The link has been debunked repeatedly since a now discredited and retracted 1998 study published in The Lancet linking the vaccine to autism. The doctor who conducted the study later lost his license for "irresponsible and dishonest" actions.
In a phone interview, Anders Peter Hviid, head epidemiologist in the recent study, talked about why his team decided to repeat their earlier research.
"Given the worrying trend in vaccine hesitancy, we felt that it was worth revisiting the link in a larger cohort with more follow-up time and also address some of the anti-vaxxer criticisms of our 2002 study," Hviid said.
"I feel passionate about good science and reason," he said. "Vaccination is the reasonable choice based on the vast majority of scientific evidence."
One of the questions that concerned parents had was related to the age the vaccination was administered and the relationship it appeared to have with the age autism symptoms presented.
Parents are told to get their children vaccinated with MMR between 12 and 15 months old. That's about the time that parents will begin to notice the regression in developmental milestones that might signal autism, Ilboudo said.
That prompts parents to make a causal connection, "even though (the study) was discredited, parents accept it as an explanation to a question no one has the answer to," Ilboudo said.
Major websites like Facebook, Pinterest and Google have taken steps toward removing vaccine misinformation online in response to repeated posts that promoted false information about vaccines.
On March 4, the president of the American Academy of Pediatrics, Kyle E. Yasuda, called upon the chief executives of Google, Facebook and Pinterest, "to work together to combat the dangerous spread of vaccine misinformation online."
Facebook released a blog post stating its plan of action.
For now, the problem persists. Anti-vaccination groups are still appearing in searches, the opposite of what was described in the blog.
A spokesperson on behalf of Instagram and Facebook announced on March 21 to the public that this is going to be a "long-term commitment."
The key is getting parents who read misinformation online to stop sharing the content and if there is a concern, to get them off the internet and engaged in an honest conversation with their child's health care provider.
But, it can be tricky.
Ultimately, Ilboudo said, building trust between parents and health care providers could reverse the trend. The key is asking the parent what their specific concerns are and addressing them with scientific evidence.
"It's about having an honest conversation with your doctor," Ilboudo said. "We don't profit off of vaccinations — we recommend them because we believe it is the best choice to prolong the child's life."