THE young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don't let your children get the vaccine for measles, mumps and rubella – it causes autism, they said.
Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota's largest outbreak of the highly infectious and potentially deadly disease in nearly three decades. Her daughter, who had a rash, high fever and cough, was hospitalised for four nights and needed intravenous fluids and oxygen.
"I thought: 'I'm in America. I thought I'm in a safe place and my kids will never get sick in that disease,' " said Salah, 26, who has lived in Minnesota for more than a decade. Growing up in Somalia, she'd had measles as a child. A sister died of the disease at age 3.
Salah no longer believes that the MMR vaccine triggers autism, a discredited theory that spread rapidly through the local Somali community, fanned by meetings organised by anti-vaccine groups. The activists repeatedly invited Andrew Wakefield, the founder of the modern anti-vaccine movement, to talk to worried parents.
Immunisation rates plummeted, and last month the first cases of measles appeared. Soon there was a full-blown outbreak, one of the starkest consequences of an intensifying anti-vaccine movement in the United States and around the world that has gained traction in part by targeting specific communities.
The current outbreak was identified in early April. As of Friday, there were 44 cases, all but two occurring in people who were not vaccinated and all but one in children 10 or younger. Nearly all have been from the Somali American community in Hennepin County. A fourth of the patients have been hospitalised. Because of the dangerously low vaccination rates and the disease's extreme infectiousness, more cases are expected in the weeks ahead.
Measles, which remains endemic in many parts of the world, was eliminated in the United States at the start of this century. It reappeared several years ago as more people – many wealthier, more educated and white – began refusing to vaccinate their children or delaying those shots.
The ramifications already have been significant.
Federal guidelines typically recommend that children get the first vaccine dose at 12 to 15 months of age and the second when they are 4 to 6 years old. The combination is 97 percent effective in preventing the viral disease, which can cause pneumonia, brain swelling, deafness and, in rare instances, death. State health officials are now recommending doses for babies as young as 6 months if there is concern for ongoing measles exposure.
Minnesota's Somali community is the largest in the country.
One father, who did not want his family identified to protect its privacy, sat helplessly by his daughter's bed at Children's Minnesota hospital last week as she struggled to breathe during coughing fits.
The 23-month-old was on an IV for fluids and had repeatedly pulled out the oxygen tube in her nose. Her older brother, almost 4, endured a milder bout. Neither had received the MMR vaccine.
The children now have antibodies to protect against measles, but they still need the vaccine to prevent mumps and rubella. Their father, who is 33 and studying mechanical engineering while working as a mechanic, wants to wait. His worry: autism. A colleague has a son "who is mute."
"I would hold off until she's 3 . . . or until she fluently starts talking," he said.
His wife no longer has doubts, however. As soon as both children are well, she said, "they are going to get the shot."