The second-greatest number of cases since ‘elimination.’
3D graphical representation of spherical-shaped, measles virus particle studded with glycoprotein tubercles. CDC/ Allison M. Maiuri, MPH, CHES
Last month, a state of emergency—which has now been halted by state court—was declared in nearby Rockland County, New York, barring children who hadn’t been vaccinated against measles from public places. The unprecedented step made worldwide news and highlights the public health measures being taken to stem the six currently ongoing measles outbreaks in the United States.
Measles was eliminated in the United States in 2000, but outbreaks have occurred since, increasingly so in recent years. The CDC reported this week that almost 400 cases of measles have been confirmed in 15 states during the first three months of this year alone. This is the second-greatest number of reported cases since eradication of the disease. The most—667 cases—occurred in 2014.
Public health authorities are clear about the cause of these outbreaks: people contract measles abroad and bring it back to the United States, where groups of people who are unvaccinated are particularly susceptible to developing and spreading this highly contagious disease. Up to 90% of unvaccinated people who come in contact with someone who has measles will contract the illness.
Insufficient immunity: a personal mystery.
Despite copious news coverage of measles outbreaks in recent years, I hadn’t given much thought to my own susceptibility, even when I traveled to places experiencing an outbreak. I was among the first generation of children to be vaccinated against the disease and had never even seen a person with measles.
But then I decided to go back to school a couple of years ago, and had to fill out a health form that requested proof of immunization. After much searching, I couldn’t locate a record of my childhood vaccinations, and my pediatrician was no longer in practice. As I scrambled to finalize my school registration and class preparations, the college’s health office, citing New York State Department of Health policy, told me I wouldn’t be allowed to attend class until I produced proof of vaccination or blood test results showing immunity.
I scheduled an appointment with my primary care physician, presuming the results of the blood test would provide me with the proof I needed. I’m not sure who was more surprised when the test revealed I was not sufficiently protected against measles. My physician didn’t recall encountering another patient who’d been vaccinated as a child but lacked immunity as an adult. I returned to her office the next day for the first of two measles, mumps, and rubella (MMR) shots.
My physician had consulted with an infectious disease specialist regarding the number of vaccine doses I’d need, but neither physician could explain why I was no longer protected against measles. Maybe I’d only received one dose of the MMR vaccine in childhood, as was sometimes the case before 1989, when a second dose of MMR vaccine was recommended for all children. (One dose is 93% effective against measles, whereas two doses is 97% effective.)
Or maybe it was because immunity can wane over time. There was no way to know for sure. The only certainty seemed to be that I never would have known—and apparently my health care providers never would have suspected—I lacked immunity to this easily prevented, potentially deadly illness had I not returned to school and lost a copy of my childhood vaccination record.
A public health challenge.
The experience has left me with renewed gratitude for the availability of vaccines, and the protection offered by a large percentage of the population being vaccinated. The World Health Organization (WHO) notes that measles killed approximately 2.6 million people each year before the 1963 introduction and widespread use of the vaccine. Describing the current vaccine as safe, effective, and inexpensive, the WHO notes that it costs about $1 to immunize a child against measles, and this cost increases only slightly when rubella and/or mumps vaccines are added.
A crucial role for nurses.
Educating and persuading communities that have low vaccination rates to immunize against measles and other diseases is a significant public health challenge, as demonstrated by the ongoing outbreaks. Nurses have been playing an important role in this outreach. To learn more about the work of one oncology nurse, Blima Marcus, in her New York City community, see “Amid a Measles Outbreak, an Ultra-Orthodox Nurse Fights Vaccination Fears in Her Community,” which appeared in a recent issue of the New Yorker.
For a primer on measles, see “Measles 101: The Basics for Nurses,” a blog post written by AJN’s clinical editor, Betsy Todd. It will be particularly useful to nurses who have never seen a case of measles.
Vaccines have been a hot topic recently because of local outbreaks of the measles. The United States (U.S.) was able to eliminate measles in 2000 but it’s coming back recently because more people are choosing not to vaccinate their children. There are some children that can’t get immunized because of age or immunosuppressing illnesses like HIV. These children are at risk of contracting preventable diseases because of the lower rates of vaccinations.
I find your blog very interesting because we had a similar experience with vaccines. When I was in nursing school, every student had to fill out health forms before starting clinical. My school required that we get blood tests done showing immunity even though you have proof of past vaccination. My parents confirmed to me that I got all my vaccinations done but my current blood tests showed I had no immunity to the illnesses tested. I was surprised because I was never educated that immunity can wane over time. I chose to get the vaccines again for my health and school. Going through that experience made me realize that I was at high risk of contracting measles and could have got sick if it wasn’t for my nursing school.
People should be informed about vaccines and the risk of not getting vaccinated. There are misleading information out there that are scaring people into believing that vaccines are dangerous. As a nurse, I want to provide evidenced-based information to patients and people of the community to show the real facts about this issue. I also want to inform people that immunity from diseases doesn’t always last forever and adults should get tested to check their immunity. We were able to eliminate measles before and we do it again.
Ms. Corinne McSpedon,
This blog was exceptionally interesting and informing for me. I am a nurse and I too, recall the process I had to go to when it came to submitting immunization records, but for nursing school. It was just another task to have checked off. After reading your blog, I would never have imagined your results even being a possibility, then. But now, I believe because of the increasing numbers of individuals who are against vaccinations, I think it is very important for people to be aware and knowledgable about their personal immunization and not just because it may be a requirement. Moreover, I recently had a discussion with friends of mine that were hearing and reading about the correlations between vaccinations and autism. I really could only listen as I did not have any knowledge on whether or not this was true. In this blog, two links were shared links: “Amid a Measles Outbreak, an Ultra-Orthodox Nurse Fights Vaccination Fears in Her Community” and “Measles 101: The Basics for Nurses.” These two posts were exceptional as well! After reading, I can definitely say that I am more knowledgable on the importance of being vaccinated and how not doing so not only affects one’s self, but a community at large.
Vaccinations growing up for me was just something that had to be done during my doctor’s visit. I never thought about it being an option, which obviously at that age it probably wouldn’t even be an option to be an option, because it was my parents decision. But even for them, it was routine; something that had to be done, and was always done. This day and age, however, because of possible misleading advertisement or information, people have become skeptical in the need for immunizations. It is blogs and articles like such that need to be openly shared to show people that vaccinations are magnificently important and significant. There was a point when I began to think maybe I shouldn’t vaccinate my child, you know? Go the holistic and natural way of life with no medicine, no shots. Then I thought, but I’m vaccinated, my siblings are vaccinated, my parents are vaccinated, so and so forth. The world we live in today doesn’t have the epidemics there once was because of the fact that our sciences and technologies have continued to grow and evolve just as we have, and provide a better quality of life by treating such diseases once heavily present. If it weren’t for science and medicines contribution to the world, our futures might night be for much long! So therefore, to vaccinate my future children is something I will absolutely do!
I think that it is essential to be aware of the source in which you are reading or gathering information from. As a result of having read your blog and those of the links you mentioned, I will absolutely be copying each link and sharing them with individuals who may benefit from learning what has been shared, just as I did.
Thank you!
As nurses we want to believe that if patients just had the facts they would make an informed decision. Research and experience shows that vaccine hesitancy is immune to the presentation of facts. At the root of this hesitancy, I believe, is a self-esteem issue that manifests itself as conspiracy beliefs about science, government, or business. These beliefs make their owner feel as if they have special information that the rest of us don’t have. They get to feel superior to us that made a risk/benefit decision based on knowledge of immunology and epidemiology.
On one anti-vaccination blog that was claiming her objection to vaccines was the supposed “toxins” they contain. I asked her if she could supervise their manufacture, and see that nothing that she considered a toxin was in the vaccine, would she use it? Her answer was still no. This refutation of any argument shows how intractable these beliefs are.
I think there needs to be qualitative research into why are the anti-vaccination posts on social media primarily from female Millennials, what is their story, and what are their motives for their postings?