In 2019, we are witnessing the biggest measles outbreak in a quarter-century. As per the latest data released by the CDC on June 6, 2019, the current number stands at 1,022. To put this in context, the US witnessed a total of 766 cases in the last 4 years combined.
How serious is the current situation?
Though a vaccine for measles has been available for the last 50 years, it is, unfortunately, reemerging as a threat for patient populations across the US. The current outbreak is the worst since 1992 and since it was officially declared eliminated in 2000. The outbreak further spread to Idaho and Virginia last week, taking the total number of affected states to 28.
Source: Centers for Disease Control and Prevention (last updated on June 6, 2019)
How did the cases of measles surge in recent times?
Measles is a highly contagious virus which can live for up to two hours in a space where the infected person coughed or sneezed. An infected person can spread measles for four days before the rash appears and up to four days after that. In fact, it is so contagious that about 90% of people around the infected person can get infected if they are not vaccinated.
Unsurprisingly, three of the most common reasons for this outbreak include:
- Parents who do not vaccinate their children
- Americans traveling to countries with high rates of measles
- People traveling to the US from other countries
The measles-mumps-rubella (MMR) vaccine is the best possible protection against measles and can effectively rule out the possibility of getting the infection. While a single dose provides 93% protection, receiving two doses increases protection to 97%. For people traveling abroad, it becomes important to get vaccinated at least 2 weeks before their departure. It is, therefore, not advisable to assume that the measles virus has been completely eradicated from the US since Americans are still vulnerable to infection from other countries, something we need to consider to better understand the bigger picture.
Prevention of measles requires “herd immunity”
While we have about 91% of our population vaccinated for measles at a national level, we often miss out on the geographic patches that may have lower levels of vaccinations. It is important to consider such factors as we aim to eliminate the cases of measles. For instance, a particular county may have a much better rate of immunization as compared to the national average, while another county or zip code may fall flat in comparison to the national average.
A near 100% vaccination rate is desirable to eradicate a particular disease. Herd immunity, as a concept, requires about 90-95% vaccination rates to make it difficult for a disease to spread easily. If only a negligible number of people are unvaccinated, the infection cannot spread across the community with ease.
Reasons behind drastic variations in vaccination rates and why is it important?
Amidst all this development, we need to re-inspect our strategies at a pediatric level. Disease prevention by vaccination should be the priority of pediatric organizations, society, and families alike. However, there are still many barriers to realizing this dream, including but not limited to:
- Reluctance from parents due to various perceived reasons
- Socioeconomic factors and lack of accessibility
- Lack of effective provider-parent communication
- Irregular wellness visits
CDC Director Dr. Robert Redfield, M.D., recently released a statement where he emphasized the importance of getting vaccinated.
“Measles is preventable and the way to end this outbreak is to ensure that all children and adults who can get vaccinated, do get vaccinated. Again, I want to reassure parents that vaccines are safe, they do not cause autism. The greater danger is the disease the vaccination prevents.”
This statement is crucial since 1 in 10 children aged 19-35 months do not receive vaccinations for MMR, with some parents even assuming that such vaccines can cause autism, something that is far away from any scientific evidence.
Ensuring 100% immunizations should be a target for every pediatric organization
While this target may seem a little ambitious, it is pretty much achievable with a concrete action plan. One of the most basic things that organizations can do is to send vaccination reminders to parents. Likewise, the care staff should be completely aware of the vaccines that they need for each visit, and they can be sent electronic reminders to ensure there is never a shortage. Pediatricians should see every visit as a potential opportunity for vaccination. Their care staff should have detailed information regarding each child’s vaccination cycle, upcoming visits, et al.
Parent education is one area that pediatric organizations should really focus on to improve child immunization rates. Parents should be told the gravity of the situation to make them understand how immunization can stop life-threatening diseases, reduce healthcare expenses in the future, and improve community health as a whole. Pediatricians can go the extra mile by further busting parents’ myths around vaccinations by listening to them for extended hours and answering all their questions so as to provide them with the most comprehensive picture. In a survey conducted by AAP, pediatricians reported that they were able to convince 30% of parents to get their children vaccinated after they initially disagreed through proper counseling and interaction.
Collaborating with local private and public child agencies to identify children who have little access to care facilities and are vulnerable to various diseases can be another step that pediatric organizations can explore. Every stakeholder, from the pediatrician to the child’s school to federal agencies, has a role to play in increasing vaccination rates. Some states, for example, require school children to be compulsorily vaccinated, except for in some specific cases. Schools, too, can grant “conditional entrance” on the promise that they will get vaccinated. Such mandates generally increase the chances of children getting vaccinated.
The road ahead
Measles still remains a big challenge for various countries around the world. No less than 10 million people are infected and 110,000 die from it each year. We, too, stand a chance to lose our measles elimination status if the trend continues until October 2019. However, this situation seems unlikely as of now. Prompt action from federal and private organizations can eliminate this threat in the US. By better synchronizing care protocols, increasing community-care provider collaboration, educating parents, and leveraging real-time updates on child vaccination status, among other things, we can reverse this trend in relatively little time. While we still have hope, acting more dynamically is the need of the hour.