Many people have the attitude that once they receive a vaccine, it is “one and done”--no worries for the future. In fact, around the year 2000, measles was thought to be completely eliminated from the United States (Centers for Disease Control and Prevention (CDC), 2018a). However, measles outbreaks are becoming a nationwide crisis and we now know that some vaccines are not life-long. Healthcare workers need to know what they should do in order to protect themselves against this potentially deadly disease.
How did this happen?
Several emerging problems have developed to create a “perfect storm” for measles outbreak. With our global community, international travel brings unvaccinated individuals from other countries into our country or allows unvaccinated individuals from our country to visit other countries bringing back the disease upon return. Just this past month, UCLA and Cal State at LA had to quarantine students due to this problem (Schwartz, 2019) and just last week, the country of Saint Lucia quarantined an American Scientology cruise ship due to a measles outbreak (Held, 2019).
In addition to this problem, many communities are experiencing lower levels of herd immunity such that those that are not vaccinated can no longer depend on herd immunity to protect them. Measles is a much more contagious disease than many others, such as polio, and even just breathing the infected airspace can spread the disease (CDC, 2018b). Measles requires 90-95% of the community be immunized to provide the correct amount of herd immunity to protect those who cannot be immunized (Oxford Vaccine Group, 2016).
This, in turn, is another problem: those that cannot be immunized; either because they are too young for the vaccine, have contraindications for the vaccine (such as pregnancy) or are immunosuppressed. These groups must rely on herd immunity but when herd immunity is low, this group is automatically vulnerable to obtaining the disease.
Why has herd immunity become so low? Several problems are thought to have contributed. One is that many states have allowed opting out of vaccinations. Some of the reasons can be due to religion, personal preference, or fear of the vaccines. Some adults in their early twenties may not have received vaccination due to the 1998 publication of Andrew Wakefield’s discredited study, linking vaccines to autism (Cunningham, 2019). In addition, some healthcare providers find it difficult to have pro-active vaccination conversations with vaccine hesitant and vaccine resistant parents. One large-scale study of pediatricians, found that there was a significant number of parents who refused vaccines in 2013 compared to 2006, and that there was also a significant number of parents who were dismissed from their practices in 2013 versus 2006 due to vaccine refusal (Hough-Telford, Kimberlin, Aban, Hitchcock, Almquist, Kratz, & O’Connor, 2016).
Lastly, many thought that the measles vaccine they received in childhood would protect them for life. Depending on the vaccination dates, the vaccination may no longer be effective. About 1 million people immunized between 1963 and 1968 were given an inactivated (“killed”) virus vaccine which was found not to be effective (CDC, 2019). In addition, the CDC found that through 1980’s measles outbreaks were still occurring, with the CDC blaming vaccine failure as one of the problems. In 1989, they began recommending two doses for all children, which began to lower outbreak rates through the 1990’s (CDC, 2018a).
What should providers know for their patients?
(Click here for CDC letter to providers)
Should you become immunized?
Healthcare workers are required to know their vaccine history. If there is no written record of vaccination, it is probably best to consult a healthcare provider to determine immunity status. If there is no proof of immunization or a question about immunity status, have a titer drawn to detect immunity. However, if measles is occurring in a community where the healthcare worker resides, they can simply skip the titer and get the measles-mumps-rubella vaccine (MMR). Even if actively immune, getting the vaccine will do no harm (unless contraindicated). Vaccination for healthcare workers (and some other groups) requires two doses of the vaccine separated by 28 days (CDC, 2019). If healthcare providers do not have the vaccine in stock, it can be found at low cost at public health departments or commercial pharmacies. For healthcare workers employed at healthcare facilities, employee health departments may be able to offer titers and/or vaccines at either no cost or low cost. For others, CDC has a vaccine finder widget to help locate vaccine providers within a designated zip code area. The widget can be found here: https://www.cdc.gov/measles/vaccination.htmlClick here for References
Sheryl Buckner PhD, RN, ANEFMay 4, 2019