Measles: Low Vaccination Rates Leaving Communities Unprotected

MARCH 22, 2019
This article was co-written with Sean Long, PharmD Candidate 2019 and Andrew Yabusaki, PharmD.

In 1978, the CDC set out to eradicate measles. The plan was to begin recommending routine vaccination for every child eligible to receive it. However it wasn’t until 22 years later, in the year 2000, that measles was officially declared “eliminated" in the United States.

Due to changes in how society perceives immunization and an increase in antivaccination beliefs, more people, including children, are not completing the recommended vaccination guidelines set forth by the CDC.1 This in turn is creating pockets of unvaccinated people who are now breeding grounds for infections that were once thought to be eliminated from the US.1,2

Measles, although highly contagious, can be prevented altogether through widespread vaccination. 

The MMR, or Measles, Mumps, and Rubella, vaccine was created to prevent common viral infections that once plagued children. Before implementation of the vaccine program, an estimated 3 to 4 million people contracted measles in the US each year.  Of those cases, only around 500,000 were reported to the CDC. Among those cases, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis.2

The first signs of a measles infection are usually similar to a cold and include cough, runny nose, watery eyes, and fever. Symptoms can begin anywhere from 1 to 3 weeks after first exposure, and worsen rapidly. Within 1 to 2 days of active infection, the infected individual may develop a rash along their hairline, a telltale sign of measles.3 

Doctors may decide to quarantine the infected individual as measles is incredibly contagious, spreading and infecting up to 90% of nonimmune people in the immediate vicinity. Doctors may also just collect samples for confirmatory testing and send the individual home, as there is no treatment other than supportive care.4

Measles itself is rarely fatal, but death or permanent brain damage, due to swelling of the brain, does happen. Complications from the infection happen quite often. Pneumonia, the most common complication, is the leading cause of death in children who contract the virus.5

There were 372 confirmed cases of measles in 2018, and 159 confirmed cases this year by February 21, 2019. Seventeen major outbreaks occurred in 2018, including 3 in pockets of unvaccinated Orthodox Jewish communities. In these communities, individuals who traveled to Israel during a measles outbreak contracted the virus before returning to the US. Overall, 82 people brought measles into the US from other countries, the highest number of imported cases since the year 2000.6 

The solution is simple: improve vaccination coverage. However, many people no longer trust that vaccines are safe or necessary. 
 
There are many options to combat the changes in personal beliefs and views surrounding vaccines. Health care providers have an obligation to educate patients as to how vaccines are made, who should get them, what is in them, and why it is so important that everyone, especially children, receive them. 

The MMR vaccine is made from live, attenuated viruses. These weakened viruses are then injected into a growth medium and allowed to multiply until they are ready to be harvested and transformed into a safe vaccine.7 As attenuated viruses are still live viruses, they provoke a strong immune response, and generally only require 1 or 2 doses in order to provide lifelong immunity. However, because they are live viruses, certain people should not receive them, including pregnant females, patients with a febrile illness, patients that have a hypersensitivity to a component of the vaccine, or immunocompromised patients.8 

Preservatives, such as thimerosal or ethylmercury, are recognized as causative agents of autism and other serious health condition.10 As a result, they are often a reason patients cite when refusing vaccination for themselves or their children. However, the MMR II vaccine is free of all preservatives, as any preservatives would kill the live viruses, thus rendering the vaccine inert. It is also essential to inform patients that thimerosal isn’t in any childhood vaccines, and hasn’t been since it was removed from all childhood vaccines in 2001.10

As health care providers, pharmacists should also explain why vaccination is so important and how many different illnesses can be prevented completely.

Currently, vaccines are capable of preventing up to 16 different diseases in children and teens. These disease include, but not limited to, hepatitis A & B, measles, mumps, rubella, polio, whooping cough, chickenpox, diphtheria, tetanus, rotavirus, haemophilus influenza type B, and seasonal influenza. The lasting impact that many of these infections could leave on a child are severe and debilitating, including mental impairment and possibly even paralysis.11

 
References
  1. Lynn, T. Low vaccination rates put some Oregon schools at high risk for measles. The Oregonian. https://www.oregonlive.com/health/2018/02/low_vaccination_rates_put_oreg.html. Accessed February 25, 2019.
  2. Centers for Disease Control and Prevention. Measles (Rubeola) – Measles History. CDC website. https://www.cdc.gov/measles/about/history.html. Accessed February 13, 2019.
  3. Centers for Disease Control and Prevention. Measles (Rubeola) – Signs and Symptoms. CDC website. https://www.cdc.gov/measles/about/signs-symptoms.html.  Accessed February 13, 2019.
  4. Centers for Disease Control and Prevention. Measles (Rubeola) – For Healthcare Professionals - Treatment. CDC website. https://www.cdc.gov/measles/hcp/index.html.  Accessed February 25, 2019.
  5. Centers for Disease Control and Prevention. Measles (Rubeola) – Complications. CDC website. https://www.cdc.gov/measles/about/complications.html. Accessed February 13, 2019.
  6. Centers for Disease Control and Prevention. Measles (Rubeola) – Measles Cases and Outbreaks. CDC website. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed February 13, 2019.
  7. U.S. Department of Health and Human Services. Vaccine Types. HHS website. https://www.vaccines.gov/basics/types/index.html. Accessed February 13, 2019.
  8. M-M-R II [package insert]. Whitehouse Station, NJ. Merck Sharp & Dohme Corp; 2017.
  9. Patient information about M-M-R II.  Whitehouse Station, NJ. Merck Sharp & Dohme Corp; 2014.
  10. Centers for Disease Control and Prevention. Thimerosal in Vaccines. CDC website. https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html. Accessed February 13, 2019.
  11. Centers for Disease Control and Prevention. For Parents: Vaccines for Your Children. CDC website. https://www.cdc.gov/vaccines/parents/diseases/index.html. Accessed February 13, 2019.


Kimberly McKeirnan, PharmD, BCACP
Kimberly McKeirnan, PharmD, BCACP
Dr. Kimberly McKeirnan, PharmD, BCACP, is a clinical assistant professor in the Department of Pharmacotherapy at the Washington State University College of Pharmacy. She joined the faculty at WSU in 2013 after spending the previous five years working as a community pharmacist. Dr. McKeirnan has been chosen as Teacher of the Year during the 2013-2014, 2014-2015, and 2015-2016 academic years by her second-year pharmacy students. She was also the faculty preceptor on an APPE cross-cultural rotation to Ecuador in 2014.rnDr. McKeirnan is passionate about research involving community pharmacy practice as it relates to public health and improving patient access to quality care services. In 2015 Dr. McKeirnan was selected for the National Association of Chain Drug Stores (NACDS) Foundation Faculty Scholars program, a year-long program focused on community pharmacy and public health research that contributes to improving patient outcomes. Dr. McKeirnan has also received a several grants to impr
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