Measles: Causes, Symptoms, Diagnosis, Treatment & Prevention

Opinion: Approach Toward Childhood Vaccinations Should Be Reevaluated

In an era where scientific advancements have transformed health care and eradicated once-deadly diseases, the resurfacing of vaccine-preventable illnesses raises alarming concerns about public health. As we witness statewide outbreaks in cases of the once-eradicated measles, we must reevaluate our approach toward childhood vaccinations.

According to the World Health Organization, childhood vaccines continue to be the most effective public health intervention in human history, saving between 3.5 million to 5 million lives each year. Vaccines, through their ability to stimulate the immune system, have prevented the spread of infectious diseases. Despite the proven success of vaccines, a growing number of parents are choosing not to vaccinate their children.

Measles, a highly contagious and potentially deadly viral infection, serves as an upsetting reminder of the consequences of vaccine hesitancy. Declared eliminated from the United States in 2000, measles has made a comeback in recent years. The reasons include skepticism about vaccine safety, the spread of misinformation via social media and the blissful dissociative reality of forgetting how contagious and deadly measles is to human beings.

Mandating childhood vaccines is not a novel concept. In fact, the United States already requires vaccinations including polio, mumps, rubella and diphtheria as a prerequisite for school entry. Exemptions for religious or philosophical reasons in some states have created pockets of vulnerability.

The economic and educational burden of preventable diseases caused by outbreaks, as we have all learned firsthand, is overwhelming. Our already damaged education system saw even harsher setbacks from COVID-19, and those problems will become exponentially worse should vaccines be withheld from children. Disease outbreaks disrupt school routines, leading to missed days and causing educational and developmental delays. With vaccine mandates, we can create a more stable learning environment, promote academic success and ensure that our future leaders can succeed.

Critics argue that mandating vaccines dismisses personal autonomy and parental rights. The reality is that there is a price for freedom, and public health must take priority. The government already places restrictions on individual freedoms, like seat belt laws or the cessation of smoking in public places. Similarly, a parent has the freedom to homeschool their child should they choose to not vaccinate their child.

Mandating childhood vaccines is a necessary step toward safeguarding the well-being of our communities. The term "herd immunity" has become a household phrase due in part to the COVID-19 pandemic. It emphasizes the importance of maintaining high vaccination rates to protect those who cannot be vaccinated. By ensuring widespread immunity, we create a shield that prevents the spread of infectious diseases and protects the most vulnerable members of our society.

To address these lapses in immunity, we need to address the root cause of vaccine hesitancy. Misinformation, propagated through various channels, has played a significant role in causing public mistrust in vaccines. Comprehensive, evidenced-based, and collaborative public health campaigns; education; and transparent communication from healthcare professionals are essential to counteract myths and provide accurate information about vaccine safety and efficacy. Mandating vaccines should also be accompanied by efforts to improve access to vaccination services. Lack of health care access can contribute to lower vaccination rates in underserved communities. In Connecticut, Chapter 169 Section 10-204a notes that any parent or guardian unable to provide a required vaccination due to cost will be paid for by the town. By addressing these disparities, we can ensure that all children, regardless of their socio-economic background, have equal access to better health outcomes.

In conclusion, the reappearance of measles and the trend toward vaccine hesitancy demands a motivated response. Mandating childhood vaccines is not only a practical solution to protect the health of our children but also an investment in the well-being, productivity and stability of our society. It is time to prioritize the health of our communities and safeguard our future through the power of mandatory childhood vaccinations.

Is it time to amend Chapter 169 sec. 10-204a and mandate childhood vaccines? What you can do to make a statement on this public health matter: If you are a parent looking for a CT vaccine provider, please visit https://www.Datawrapper.De/_/R0OUx/ or call 860-509-7929. If you feel motivated about mandating vaccines, join the CT Immunization Coalition, which is dedicated to promoting vaccinations through the community. As always, you can contact your local health representatives or the state Department of Public Health to express your concerns.

Peyton Teske is a lifelong Connecticut native and has been a registered nurse since 2020. She is currently in the AGACNP program at UConn.

Understanding Measles And The Role Of Vaccination

With measles cases rising in Canada and internationally, it is important for clinicians to understand the disease and the role of vaccination against measles. Two practice articles in CMAJ (Canadian Medical Association Journal) https://www.Cmaj.Ca/lookup/doi/10.1503/cmaj.240415 https://www.Cmaj.Ca/lookup/doi/10.1503/cmaj.240371 provide succinct overviews of this highly infectious disease. Many clinicians may not have direct experience with measles diagnosis and treatment as Canada achieved measles elimination status in 1998.

The increase in measles activity globally and in Canada is a reminder of the importance of immunization. Routine childhood vaccines, including measles, that were missed during the COVID-19 pandemic should be urgently caught up. Clinicians should also be on the alert for measles when evaluating patients, especially those with a history of travel or those who might have been exposed in local outbreaks"

Dr. Sarah Wilson, author, physician at Public Health Ontario

Measles is one of the most contagious respiratory infectious diseases. Individuals with measles develop fever, cough, runny nose, and conjunctivitis. A rash that starts on the face and spreads throughout the body can then follow, about 4 days later. Complications from measles infection are reported in 30% of cases. These can include ear infections, pneumonia, pregnancy complications, and neurologic complications, including encephalitis. Measles can also cause temporary secondary immunodeficiency. Most measles cases in Canada occur in unvaccinated people, especially children.

Given how infectious measles is, health care providers should pre-emptively contact health care facilities if they are referring suspect cases to be evaluated or tested, to ensure that appropriate infection prevention and control measures are used to avoid exposing other patients and staff. 

Despite effective vaccination programs, measles outbreaks are increasing, emphasizing the need for heightened vaccination efforts. The Canadian Immunization Guide recommends the administration of the measles, mumps, and rubella (MMR) vaccine for all individuals in Canada, with specific dosing schedules and catch-up recommendations.

For travel or outbreaks, MMR vaccination can occur beyond standard schedules, with guidelines provided for accelerated vaccination and postexposure prophylaxis. Adults without measles immunity or vaccination records can receive 1–2 doses of the MMR vaccine, depending on their age, travel history, and risk factors. The MMR vaccine is safe and effective. However, individuals with immunocompromised conditions require careful consideration.

"Measles is highly contagious and making a comeback worldwide. The measles vaccine is effective and safe. However, those who are immunocompromised or pregnant are not able to receive it. Herd immunity through mass vaccination is therefore critically important. Our paper summarizes who should get the vaccine outside of the typically recommended schedule, particularly children, who are particularly vulnerable to measles complications. We also provide guidance for adults to receive 1 or more doses of the vaccine, depending on their year of birth, travel or residence in an area affected by outbreaks, and occupation," says Dr. Samira Jeimy, program director and assistant professor, Clinical Immunology and Allergy, Western University, London, Ontario.

Source:

Journal references:

Many Healthcare Workers Unsure About COVID Vaccine Boosters For Themselves, Kids

A survey of more than 4,100 healthcare personnel (HCP) at a New York healthcare system from 2021 to 2022 reveals that 17% were hesitant to receive the recommended COVID-19 vaccine booster, and 33% were unsure about vaccinating their children. 

Many of the HCP polled held unsubstantiated beliefs not only about COVID vaccines but also childhood vaccines.

Almost two-thirds had patient contact

The Northwell Health–led study, published in Vaccine, involved 4,165 HCP who completed the mandatory COVID-19 primary vaccine series, had intact immune systems, and took electronic surveys from December 2021 to January 2022. The aim was to identify links between sociodemographic and employment factors and perceptions of COVID-19 vaccines among HCP overall and a subset who had children.

New York state mandated that all HCP, regardless of job role and title, receive the first dose of the primary COVID-19 vaccine series by September 27, 2021, as a requirement for employment. During the study period, the booster dose was recommended but not mandated.

Respondents were primarily women (83.1%), and age, race, and languages spoken were evenly distributed. Of the respondents, 42.4% had high patient contact, and 22.9% had some contact. The largest percentages of HCP were nurses (26.0%), clinicians (10.5%), and other providers (4.4%).

Worries about vaccine safety, efficacy

An estimated 17.2% of administrative and clinical HCP were hesitant to receive the state-recommended COVID-19 vaccine booster, and 32.6% were unsure about having their children vaccinated, regardless of whether the HCP had a clinical role.

A large proportion of respondents were unsure about the COVID-19 vaccine's effects on infertility (33.3%), miscarriage (37.0%), DNA changes (23.1%), and immune response (21.7%). A total of 46.4% were unsure about any link between COVID-19 vaccines and myocarditis, and 47.0% were moderately to extremely confident about discussing common vaccine concerns. 

A small fraction of HCP (6.9%) said childhood vaccines were unsafe and that the risks didn't outweigh the benefits (2.5%) and didn't prevent disease (2.6 %).

The vast majority (85.3%) said COVID-19 vaccination was important to them, 60.0% indicated that their strong recommendation for vaccination would affect a patient's decision to vaccinate, and 68.0% said the COVID-19 vaccine, based on US Food and Drug Administration emergency use authorization, was safe for children.

In total, 64.9% of HCP with children and 70.1% without children received a booster dose—a higher rate than in the general population during the study period. 

A small fraction of HCP (6.9%) said childhood vaccines were unsafe and that the risks didn't outweigh the benefits (2.5%) and didn't prevent disease (2.6 %). A third of respondents (32.8%) said the current childhood vaccination schedule was too taxing on a child's immune system. 

Overall, 45.0% of HCP indicated that parents should decide whether vaccines are given to their children, even if their opinions and beliefs countered scientific evidence on vaccinations, and 61.0% said delaying recommended vaccines for several visits after their recommended schedule was OK. In total, 30.0% believed that parents and caregivers should be able to request nonmedical exemptions for school entry. 

HCPs who were not parents were much less likely than parents to hesitate about vaccinating themselves (prevalence ratio [PR], 0.61), and a significant percentage of parents of children older than 5 years were reluctant to vaccinate their children in general (PR, 1.15). Of respondents with vaccinated children of any age, hesitancy was about half that of those with unvaccinated children (PR, 0.52 for parents of children aged 5 to 11 years; PR, 0.58 for parents of children aged 12 to 17 years).

HCP hesitancy compromises patient care

Regression analyses indicated that Black (PR, 1.35), Hispanic (PR, 1.35), and American Indian/Alaska Native (PR, 1.74) HCPs were about 1.5 times more likely, and White (PR, 0.63) and Asian (PR, 0.53) respondents were about half as likely, to be vaccine-hesitant than multiracial HPCs. 

Women and respondents who were younger, earned lower incomes, had fewer years on the job, lived in Manhattan, and hadn't previously received a COVID-19 booster were significantly more likely to be vaccine-hesitant. Bilingual respondents were 2.5 times more likely to be vaccine-hesitant than English-only speakers. 

High vaccine hesitancy among HCP for COVID-19 vaccination and booster doses parallels high vaccine hesitancy for pediatric COVID-19 vaccination, thereby having a downstream community impact.

The study authors noted that while HCP recommendation has been the main method of overcoming patient COVID-19 hesitancy, understanding vaccine reluctance requires a more integrated rather than a "top-down" approach, because HCPs are more hesitant than ever about vaccination.

"Provider recommendation is compromised at point of care when surrounding HCP, despite having already received their standard COVID-19 doses, still question the need for vaccination and subsequent booster doses," they wrote. "Furthermore, high vaccine hesitancy among HCP for COVID-19 vaccination and booster doses parallels high vaccine hesitancy for pediatric COVID-19 vaccination, thereby having a downstream community impact."

A more grass-roots approach to HCP education is needed: "Our next step is to reach out to focus groups volunteered from this survey population and determine if this subpopulation will be instrumental in developing training modules for COVID-19 vaccination. As the pandemic continues to evolve into endemic status, our global approach to vaccine hesitancy requires diversification, innovation, and approaches yet to be discovered."

---