By Tamara K Robison, DDS, MBA, PA, Board Certified Pediatric Dentist – Naples and Marco Island
The recent rise in vaccine-preventable diseases is a cause for real concern among healthcare providers and parents. The Centers for Disease Control and Prevention reported over 600 new cases of measles in the United States in 2014. Between January 2015 and April 2015, 166 cases have been documented in 19 different states.1 The virus is transmitted through the air and by direct contact. It can remain viable and infective one to two hours after the asymptomatic infected person has left the area.5
The percentage of people who are exposed to the virus and will develop measles is approximately 90%, unless they have been vaccinated or have previously had measles.2 A community is at greater risk of an epidemic outbreak when the vaccination rate falls below 95% of the population.1 Measles is one of the most contagious diseases known and spreads fast in people who have a weak immune system. This especially at risk population includes patients with cancer or transplants and patients with congenital immune deficiencies. Other groups at risk are unvaccinated infants too young to vaccinate, children of vaccine hesitant parents and immigrants. The disease can cause serious illness. Death from pneumonia complications have occurred.1 If a woman acquires measles during pregnancy it can result in miscarriage or still birth.2
Despite strong scientific evidence supporting the safety of vaccinations, many parents have decided to intentionally delay or refuse to have their children vaccinated. Contributing to the vaccine hesitancy movement has been Internet and social media influence, healthcare system distrust, and dissatisfaction with governmental oversight. Many states provide for medical, religious or philosophical exemptions from the required immunizations for entry into school. Affluent private schools have an exemption rate 50% higher than public schools. An investigation found that the majority of unvaccinated infants in this group were more likely to be white, male, and have college educated parents with an annual income of $75,000 or greater.1
What can healthcare providers and parents do to work together to prevent the continued reemergence of preventable diseases in our community, while respecting the rights and responsibilities of each other. It is essential that parents who have decided to delay or not immunize their children let their healthcare provider know. It is also important that parents inform the school or childcare provider of the vaccination status of their children.3 Soon it will be incumbent upon healthcare providers to require patients to provide their vaccination status. Parents need to have records of vaccination up-
to-date and readily available upon request. Staff
members of the healthcare team should also have up-to-date immunization records as part of their employee personnel files. An immunization schedule guideline is available with the Florida Health Department: http://www.floridahealth.gov/
programsand-services/immunization/children-and-
adolescents/_documents/baby-shots-eng.pdf. 6
Simple Precautions can be taken by your healthcare provider to protect the most vulnerable of our patients that may be in the waiting room at the same time, but we can only protect patients if we know the status of your children’s vaccination history. Families need to accept this additional, possibly burdensome, new requirement with understanding. It indicates that the dentist or physician is committed to the safety and health of all patients and members of the healthcare team.2
Parents that are vaccine hesitant can have a simple blood test performed to test the child for natural immunity against the virus.4 If an outbreak happens in your community and you want to reconsider the decision not to vaccinate, it might not be too late. Contact your child’s doctor to find out. If you have informed the school or childcare provider, they may request that you take the unvaccinated child out of school and away from organized sports. The facility will inform you when it is safe for the child who is unvaccinated to return. The required time away could be several days up to weeks. Educate yourself about the disease by contacting your local health department and your child’s doctor. Ask how the disease is spread, how long it lasts, what are the signs and symptoms, and how long the time is from exposure to when signs and symptoms may appear. The Centers for Disease Control and Prevention has photos of people with measles. Available at: http://www.cdc.gov/measles/about/photos.html 7
Several cases have been confirmed in Florida this year.8,9 Physicians and dentists need to stay informed regarding the reemergence of vaccine-preventable diseases and take steps to minimize
the risk of transmissions in our offices. We need to
understand that affluent communities may have higher rates of vaccine hesitant parents with higher percentages of under vaccinated children.1 To refuse to see an unvaccinated and uninfected patient would be unethical. Appointments for unvaccinated patients that have been exposed or are showing signs and symptoms should be delayed. If an outbreak in the community does occur, ask all patients during reminder and confirmation calls or upon arrival to the appointments, whether exposure is a possibility. Place a sign in the waiting room area requesting families to inform the office of any possibility of exposure. If a patient presents to the office with a suspected exposure that is not requiring immediate medical attention, send the patient home and consult with the patient’s physician. If you send the patient to the physician’s office this could result in both offices being exposed. Contact your local health department and inform them of the situation. The other people who were in the office at the same time may need to be contacted if the jurisdiction allows for this type of patient information disclosure. Some vaccine-preventable diseases have medicines available to minimize the risk to those the child has come into contact.3
Healthcare providers can be a resource for information by providing high quality patient education material. We can highlight the topic and have more frequent discussions regarding the safety and responsibility to vaccinate. In the effort to advocate for the safety and welfare of all involved parties and our community, the healthcare team should be cautious not to insult people who are vaccine hesitant. Instead, we should respectfully suggest that this decision has the risk of putting our community in danger of preventable diseases.3
References
1 Glick, M.Vaccine hesitancy and unfalsifiaibility: Editorial. JADA July 2015; 146(7) 491-493.
2 Gordon,S. MacDonald,N. A Safer Dental Visit Managing Measles in a Dental Practice A forgotten Foe Makes a Comeback: JADA July2015; 146(7) 558-560.
3 Centers for Disease Control and Prevention. If you choose not to vaccinate your child, understand the risks and responsibilities. Available at: http://www.cdc.gov/vaccines/hcp/patiented/conversations/downloads/
not-vacc-risks-color-office.pdf
4 Blood Test can Determine Measles Immunity. Available at: http://fox5sandiego.com/2015/01/23/blood-test-can-determine-measles-immunity-experts-say/
5 Public Health Agency of Canada. Measles Virus Pathogen Safety Data Sheet Infectious Substances Survival outside host. Available at: http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/measles-rougeole-
eng.php
6 Florida Health Department. Babyshots. Available at: http://www.floridahealth.gov/programsand-services/immunization/
children-and-adolescents/_documents/baby-shots-eng.pdf
7 Centers for Disease Control and Prevention. Photos of measles and people with measles. Available at: http://www.cdc.gov/measles/about/photos.html
8 Palm Beach Post. St Lucie health department confirms second case of measles. April 24, 2015. Available at: http://www.palmbeachpost.com/news/news/local/st-lucie-health-
department-confirms-second-case-of/nk3Q8
9 NBC. Two measles cases reported in Indian River County. April 19, 2015. Available at: http://www.nbc-2.com/story/28841556/two-measles-cases-reported-in-indian-river-county#.VbUgBtJViko