LOS ANGELES -- Los Angeles health officials warned this week that students and staff at the University of California, Los Angeles and Cal State L.A. may be at risk of catching measles, an announcement that has raised questions about universities' susceptibility to disease outbreaks.
Not only can cramped dorm rooms and crowded classrooms be breeding grounds for contagion, but young adults in California are less likely to be vaccinated than other age groups, experts say. One of the people infected in L.A.'s measles outbreak is a UCLA student, university officials confirmed Tuesday.
People who are now in their early 20s are part of what's known as the "Wakefield generation," because they were infants in 1998 when British scientist Andrew Wakefield published a now discredited paper claiming that vaccines cause autism. Scared of the side effects of vaccination, many parents chose to opt out.
California implemented one of country's strictest immunization laws in 2016 to try to push up vaccination rates, but high school students and young adults who had already finished their schooling when the law took effect were not required to comply. That has left a large pool of young people especially vulnerable to infections, experts say.
"Our eyes are always focused on these elementary schools ... but (vaccine refusal) been going on for a while now, so you have undervaccinated kids becoming undervaccinated adults," said UC Riverside professor Richard M. Carpiano, a medical sociologist who studies vaccine hesitancy. "This is a higher education issue."
Nationwide, health officials are grappling with a surge in measles cases that is approaching a 20-year high. California is one of 22 states where measles cases have been reported in 2019, according to federal officials.
L.A. County officials announced Monday that they are investigating an outbreak involving four people as well as one standalone case. There have been at least 25 measles cases in California this year, most linked to a cluster in the northern part of the state.
The UCLA student who was recently infected attended classes for three days in early April while infectious, according to a statement from UCLA spokesman Ricardo Vazquez. Though there is currently no risk of catching measles on campus, officials say that people who came near the student may have contracted measles.
Measles spreads through coughing and sneezing, and up to 95 percent of unvaccinated people who are exposed to measles will develop the illness, said Dr. Vikram Anand, a pediatric infectious disease specialist at Children's Hospital Los Angeles. Even after a sick person leaves a room, the virus can linger in the air for up to two hours, waiting to infect an unsuspecting victim.
"Measles is probably the most contagious disease on the planet," Anand said.
L.A. health officials say the majority of people who came down with measles were unvaccinated, but would not provide specific information about each patient.
Democratic state Sen. Richard Pan of Sacramento, who authored California's vaccine law, said that people now in their early 20s have a high chance of not being vaccinated because they were young children when Wakefield appeared on "60 Minutes" in the U.S. and anti-vaccine activist Jenny McCarthy began warning of the dangers of vaccines.
"It's that generation," he said. "It's accumulated over time -- a large number of unvaccinated people."
The last big measles outbreak in L.A. County, which was in 2017, centered around unvaccinated older adolescents.
In the fall of 2011, roughly 11,500 students starting seventh grade did not have all their shots, largely because their parents said it was against their personal beliefs.
That number dropped to approximately 2,100 by the fall of 2017, in large part because of a law Pan authored barring parents from skipping vaccines because of their personal beliefs.
But people who already crossed seventh grade in 2016 when the law took effect were grandfathered into the law and did not need to get vaccinated to complete their schooling. Kids who were in seventh grade in 2011 would be college sophomores now -- and still may not have their vaccines.
Some young adults whose parents did not vaccinate them are now choosing to get vaccinated on their own, but that is rare. Some children say they didn't know their parents didn't vaccinate them.
"Policy-wise, the approach our country has taken, and many other countries, is that we require vaccinations for school," Pan said. "What happens if someone misses that window? We haven't really developed a mechanism to go back."
In 2015, the UC system approved a regulation requiring that students be fully vaccinated before enrolling at any campus. At California universities in the past decade, there have been outbreaks of mumps, meningitis and norovirus.
But amid pushback, UC officials did not begin enforcing the regulation until fall 2018, the beginning of the current school year. Therefore, most students at UCLA enrolled before the requirement took effect.
Nationwide, an estimated 626 people have come down with measles as of Friday, the second-highest number of cases reported since measles was declared eliminated in the country in 2000, according to the U.S. Centers for Disease Control and Prevention.
Experts say the increase is due to fewer people being vaccinated in the U.S. and across the world; Americans are now more likely to encounter measles abroad, and when they return, the infection is more likely to spread here.
L.A. officials say the outbreak as well as the single case were both linked to international travel. The Northern California outbreak began when a man contracted measles in the Philippines.
This week, health officials also warned that someone infected with measles spent time in the library at Cal State L.A. for a few hours in April. University spokesman Robert Lopez said health officials had not said if the patient was a student.
The Cal State system requires that all students be vaccinated against measles and hepatitis B to begin classes, though it often allows a one-year grace period for students to catch up on their immunizations. Starting in fall 2020, CSU students will also be required to also be immunized against meningitis, whooping cough and chickenpox.
Though measles is most deadly for babies under a year old, children younger than 5 and adults older than 20 are more likely to suffer from other serious complications, such as pneumonia, brain swelling and ear infections that can lead to permanent hearing loss.
Public health officials encourage vaccination, estimated to be 97 percent effective in protecting against measles. The measles vaccine is believed to work for a lifetime.
"We will likely see additional measles cases in Los Angeles County, so ... the best way to protect yourself and to prevent the spread of measles is to get the measles immunization," said L.A. County health officer Dr. Muntu Davis in a statement.
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