“Wait, wasn’t that eradicated?” That seems to be the collective response of healthcare workers each time a long-forgotten childhood disease reemerges as a serious public health threat in the United States. Evening news programs report on these outbreaks frequently and for us on the front lines, it’s a frightening development. In the media, much of the attention is focused on the anti-vaccine movement, a coalition of parents, politicians and celebrities who believe vaccinations do more harm than good to children. Namely, the controversy stems from an unsubstantiated link between childhood vaccinations and autism, a cause backed by high-profile endorsements but little science. Still, it’s unfair to lay all the blame for the current public health scares on “anti-vaxxers” alone: Individuals who don’t know their immunity history may be playing a role in spreading these diseases. According to the U.S. Centers for Disease Control and Prevention, between Jan. 1 and Jan. 23, 2015, 68 people from 11 states contracted measles. The majority of these cases were part of a large, ongoing outbreak linked to an amusement park in California, and involved unvaccinated individuals. But not everyone infected in the latest high-profile measles outbreak was unvaccinated as a child. Many were, but immunizations – including measles – frequently require “boosters” to ensure lasting protection. Chances are, some of those infected individuals did not receive these important follow-up vaccinations and were unknowingly susceptible. For healthcare workers and private citizens alike, these less-publicized infections highlight the importance of adhering to industry-recommended vaccine guidelines throughout our lifetimes for dangerous increasingly common viruses and bacterial infections that can cause public health issues if left uncontrolled. Measles Also known as Rubeola, this highly contagious disease spreads quickly through coughing and sneezing. Measles starts with a fever, runny nose, cough, red eyes and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more serious complications, including pneumonia, ear infections or diarrhea. Complications also are more common in adults and young children. If you’ve never received a measles vaccination — or if the immunization was unsuccessful — there’s a 90 percent chance you’ll be infected if you come in contact with the virus. The results can be lethal: For every 1,000 children that contract the disease, one to three will die of the respiratory ailment, according to the CDC. Mumps Mumps infections also appear to be trending upwards. According to the CDC, there were 1,151 mumps infections in 2014, up from less than 500 the year prior. In November 2014, the CDC began investigating mumps outbreaks among professional hockey players, some of whom were immunized as children against the highly contagious virus. Currently, there is no approved treatment for mumps, and it has been known to cause long-term health problems. Pertussis Commonly called “whooping cough” or “100-day cough,” pertussis also is experiencing a spike in the United States. After a vaccine was introduced in the 1940s, U.S. pertussis cases dropped from 100,000-plus per year to fewer than 10,000 by 1965. Four decades later, the highly contagious bacterial infection had reemerged: In 2012, there were 42,000 reported whooping cough cases in the United States. During infection, bacteria attach to the cilia in the upper respiratory system and release toxins. The resulting damage causes inflammation, which leads to coughing and breathing problems. Vaccine guidelines Pertussis vaccines lose their effectiveness over time, and booster shots are required for individuals to maintain immunity against the disease. For recipients of the childhood MMR vaccine, there’s a 2 percent to 5 percent chance the immunization was not successful; in these cases, a second dose is recommended. Meanwhile, the MMR vaccine is about 80 percent effective in preventing mumps with one dose, while two doses result in 90 percent statistical effectiveness at preventing infection. For all healthcare workers born after 1957, the Advisory Committee on Immunization Practices recommends adequate presumptive evidence of immunity to measles and mumps, which is defined as documentation of two doses of measles and mumps vaccine or laboratory evidence of immunity. Further, ACIP recommends that healthcare facilities consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory evidence of having had these diseases or do not have laboratory tests that show immunity. During an outbreak of measles or mumps, healthcare facilities should recommend two doses of MMR separated by at least four weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of disease. On its website, the CDC provides the following specific vaccination guidelines for healthcare workers, including physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff: Hepatitis B: If you don’t have documented evidence of a complete hepB vaccine series, or if you don’t have an up-to-date blood test that shows you are immune to hepatitis B (i.e., no serologic evidence of immunity or prior vaccination) then you should get the 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). Get anti-HBs serologic tested 1–2 months after dose #3. Flu (Influenza): Get 1 dose of influenza vaccine annually. MMR (Measles, Mumps, & Rubella): If you were born in 1957 or later and have not had the MMR vaccine, or if you don’t have an up-to-date blood test that shows you are immune to measles or mumps (i.e., no serologic evidence of immunity or prior vaccination), get 2 doses of MMR (1 dose now and the 2nd dose at least 28 days later). If you were born in 1957 or later and have not had the MMR vaccine, or if you don’t have an up-to-date blood test that shows you are immune to rubella, only 1 dose of MMR is recommended. However, you may end up receiving 2 doses, because the rubella component is in the combination vaccine with measles and mumps. For HCWs born before 1957, see the MMR ACIP vaccine recommendations. Varicella (Chickenpox): If you have not had chickenpox (varicella), if you haven’t had varicella vaccine, or if you don’t have an up-to-date blood test that shows you are immune to varicella (i.e., no serologic evidence of immunity or prior vaccination) get 2 doses of varicella vaccine, 4 weeks apart. Tdap (Tetanus, Diphtheria, Pertussis): Get a one-time dose of Tdap as soon as possible if you have not received Tdap previously (regardless of when previous dose of Td was received). Get Td boosters every 10 years thereafter. Pregnant HCWs need to get a dose of Tdap during each pregnancy. Meningococcal: Those who are routinely exposed to isolates of N. meningitidis should get one dose. For more information on these diseases and the vaccinations, please visit the Vaccine Information Statements (VIS) forms on CDC’s website. Please be aware that each state also has recommendations/requirements for healthcare worker immunizations and vaccinations. To research the information for your state, please visit the “State Immunization Laws for Healthcare Workers and Patients” tab on CDC’s website. When you research your state immunization laws, please note the recommendations for an ambulatory care center may be different than that of a hospital. Make sure you are following the recommendation that best fits your facility. Your center should have clear policies to support the vaccination requirements for employees and physicians who work within your facility. Your infection control program should include a plan for educating your employees about the latest outbreaks in your area and what type of symptoms they should report to the infection control nurse or the local health department. For more information on immunizations and healthcare workers, please contact amingus@regentsh.com.
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