Survey finds increased parental vaccine acceptance in aftermath of California measles outbreak A survey conducted by Medscape found that fewer parents may be refusing to vaccinate their children in the aftermath of the California measles outbreak, especially in western states, which have had some of the highest refusal rates in America. According to the Medscape Vaccine Acceptance Report, an online survey of 1,577 pediatricians, family physicians, public health physicians, nurse practitioners and physician assistants that was conducted last month, 42 percent of clinicians said they believed more parents are accepting vaccines and 38 percent said parents are more accepting of the measles vaccination in particular. Health care professionals in the western region of the country, including California, Alaska, Hawaii, Montana, Idaho, Oregon and Washington, reported even higher rates of acceptance for the measles vaccines (46 percent vs. 36 percent for the rest of the country) and for all vaccines (51 percent vs. 41 percent). The survey did find, however, that unfounded worries about vaccines still remain in parents’ minds. Sixty-four percent of clinicians said parents fear complications and 61 percent said parents fear a connection to autism. Half said parents worried about added ingredients such as thimerosal and 45 percent said parents expressed concerns about immunization overwhelming a child's immune system. A majority of clinicians surveyed (69 percent) said they provide evidence-based information to address specific parental concerns. Clinicians also said that they create a customized approach and share potential morbidity and mortality statistics on vaccine-preventable diseases. Eight percent of providers surveyed said that they refuse to accept families in their practice who will not adhere to the recommended vaccination schedule Although all states require schoolchildren to be vaccinated, 18 states let parents opt out based on religious or philosophical beliefs, according to the National Conference on State Legislatures. About 23 percent of those surveyed reported that concern about being refused admission into some schools, camps and day care centers played a significant role in parents' change of heart. Twenty-one percent of respondents attributed the more open attitude to parents further educating themselves about the issue. California Gov. Jerry Brown signed a bill in June 2015 that will eliminate religious and philosophical exemptions in the state beginning in 2016. August 28, 2015 General Measles, Public Health, Vaccination, Immunization 0 0 Comment Read More »
New study concludes that vaccine refusal helped fuel Disneyland measles outbreak A new study conducted by research teams from MIT and Boston Children’s Hospital has concluded that parental resistance to vaccinations played a role in the Disneyland measles outbreak that started in January. The analysis, published in JAMA Pediatrics, showed that the highly contagious disease has spread to seven states and two other countries, largely because parents did not vaccinate their children. The study’s authors used simple math to determine that the vaccination rate among people who were exposed to measles during the outbreak was no higher than 86 percent, and might have been as low as 50 percent. At least 96-99 percent of the population must be vaccinated to establish herd immunity. The study underscores the need for childhood vaccinations to prevent more outbreaks. Vaccination rates with the measles, mumps and rubella (MMR) vaccine in many of the communities that have been affected by the measles outbreak fall well below the necessary threshold to sustain herd immunity, thus placing the greater population at risk in addition to the unvaccinated, the researchers concluded. Measles is a highly infectious viral disease that remains a leading cause of death in children worldwide. After patients cough or sneeze, the virus particles can survive as long as two hours on doorknobs, hand rails, elevator buttons and even in the air. According to the World Health Organization, about 400 people died from measles every day in 2013. However, before vaccination became widespread, the disease killed about 2.6 million people per year. The study authors said that the index patient in the Disneyland outbreak was probably exposed to measles overseas and then visited the Anaheim amusement park while contagious, according to the Centers for Disease Control and Prevention. This particular strain of measles is identical to one that spread through the Philippines last year, where it sickened about 58,000 people and killed 110. No deaths have been traced to the Disneyland outbreak. According to the authors of the study, the extent of the Disneyland outbreak is a reflection of the anti-vaccination movement, which continues to grow despite overwhelming medical evidence that the MMR vaccine does not cause autism or other developmental problems. In most cases, side effects are limited to pain at the injection site, fever, a mild rash or temporary swelling. In rare cases, children may have a severe allergic reaction to the vaccine or develop febrile seizures, joint pain, temporary arthritis or a blood disorder called immune thrombocytopenic purpura. To see the study, click here. SB 277 (Pan) is currently moving through the legislature and would remove the option for a personal belief exemption for immunizations, unless medically necessary. The California Medical Association supports the bill, which was recently endorsed by the Sacramento Bee. March 23, 2015 General Measles, Public Health, Vaccination, Immunization 0 0 Comment Read More »
Legislation announced to ban personal belief exemptions for school vaccinations With the number of California measles cases now at 103 and growing, Sacramento pediatrician and State Senator Richard Pan, M.D., has announced his intention to introduce legislation to repeal personal belief exemptions for school vaccinations. Cosponsoring the repeal with Dr. Pan is Sen. Ben Allen, D-Redondo Beach. Joining Senators Pan and Allen at the press conference announcing their bill were Senators Hannah Beth Jackson and Lois Wolk and Assemblymember Lorena Gonzalez. The same day, Senators Dianne Feinstein and Barbara Boxer urged California to revisit the law allowing personal belief exemptions. In addition, Governor Jerry Brown said last week that he "believes that vaccinations are profoundly important and a major public health benefit, and any bill that reaches his desk will be closely considered." In 2012, Dr. Pan also authored California Medical Association-sponsored AB 2109, which requires a parent or guardian seeking a personal belief exemption from school immunization to first obtain a document signed by a licensed health care practitioner. Since the bill took effect in 2014, the number of parents in California who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has dropped by 20 percent, with 2.5 percent of kindergarten children opting out this school year, down from 3.1 percent last year. In some communities, however, as many as 10 percent of parents continue to file personal belief exemptions. “As a pediatrician, I have personally witnessed children suffering life-long injury and death from vaccine-preventable infection,” said Dr. Pan. “While I am pleased that more families are choosing to immunize their children and the statewide rates are going in the right direction, it is important to know that there are pockets of the state where the low vaccination rates continue to put children at risk,” he said in a press release issued two weeks ago. The bill would still allow exemptions for children who cannot be vaccinated for medical reasons. It would also require that parents be notified of the vaccination rates at their children's schools. February 18, 2015 General Measles, Public Health, State Legislation, Vaccination, Immunization 0 0 Comment Read More »
California measles cases now at 68 The California Department of Health Care Services (DHCS) confirmed today that the number of measles cases in the state has grown to 68 California residents with a number of additional suspected cases under investigation. Infected individuals range in age from seven months to 70 years. The vaccination status is documented for 34 of the 68 cases ΜΆ 28 patients were unvaccinated (six were infants too young to vaccinate), one patient had received only one dose of the MMR vaccine and five had received two or more doses of MMR vaccine. The California measles patients reside in 11 local health jurisdictions: Alameda, Los Angeles, Orange, Riverside San Bernardino, San Diego, San Mateo, Santa Clara and Ventura Counties and the cities of Long Beach and Pasadena. While most (48 cases) fell ill after visiting Disneyland or Disney California Adventure in December, DHCS has confirmed that additional people visited the Disney parks while infectious in January causing new infections beyond what they had originally thought was the exposure window. CDPH advises physicians that because there have been new cases of measles in persons who have not been international travelers or visited theme parks, measles should be considered in patients of any age who have a fever and a rash. Fever can spike as high as 105° F. Measles rashes are red, blotchy and maculopapular and typically start on the hairline and face and then spread downwards to the rest of the body. Physicians should also obtain a thorough health history on such patients, including prior immunization for measles. If you suspect your patient may have measles, isolate them immediately and alert your local health department as soon as possible. If measles is suspected (see CDPH infection control guidance), do not allow suspect measles patients to remain in the waiting area or other common areas. For additional infection control information, please see the CDC “Guideline for Isolation Precautions.” Post-exposure prophylaxis can be administered to individuals who have come into contact with an infected patient within 72 hours of exposure (MMR vaccine) or up to six days after exposure (immune globulin - intramuscular). Please consult with your local health department regarding appropriate administration. Click here to read the health advisory. January 29, 2015 General Measles, Public Health, Infectious Diseases 0 0 Comment Read More »
Measles Health Advisory HEALTH ADVISORY – January 7, 2015 Measles has been confirmed in seven California residents in 2015 and two Utah residents; all visited Disneyland or Disney California Adventure Park between December 17th and 20th, 2014. Testing is underway on three additional California residents who also visited Disneyland during this same time period. The California confirmed cases reside in five local health jurisdictions and range in age from 8 months to 21 years. Of the seven confirmed cases, six cases were unvaccinated for measles (2 were too young to be vaccinated, and 1 had received appropriate vaccination (two doses of MMR vaccine). Several large contact investigations are ongoing. To prevent additional measles cases, California healthcare providers are recommended to: Remember the diagnosis The recent cases in California highlight the need for healthcare professionals to be vigilant about measles. Your expert eye, diagnostic skills, and prompt reporting of suspect measles patients to public health can make a difference in stopping the spread of this highly contagious disease in your community: Consider measles in patients of any age who have a fever AND a rash regardless of their travel history. Fever can spike as high as 105°F. Measles rashes are red, blotchy and maculopapular and typically start on the hairline and face and then spread downwards to the rest of the body. Obtain a thorough history on such patients, including: Travel outside of North or South America or contact with international travelers (including transit through an international airport or a visit to an international tourist attraction in the United States) in the prior three weeks. However, since measles cases have occurred throughout California undetected community transmission cannot be ruled out; and Prior immunization for measles. Please note that although documentation of receipt of two doses of MMR vaccine or a prior positive measles IgG test result makes the diagnosis of measles less likely, measles can still occur in such persons. If you suspect your patient may have measles, isolate the patient immediately (see below) and alert your local health department as soon as possible. The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately. Post-exposure prophylaxis can be administered to contacts within 72 hours of exposure (MMR vaccine) or up to 6 days after exposure (Immune globulin - intramuscular). Please consult with your local health jurisdiction regarding appropriate administration. Collect specimens for measles testing: Draw 7-10 ml blood in a red-top or serum separator tube; spin down serum if possible. NOTE: capillary blood (approximately 3 capillary tubes to yield 100 µl of serum) may be collected in situations where venipuncture is not preferred, such as for children <1 year of age. Obtain a throat or nasopharyngeal swab; use a viral culturette and place into viral transport media. Collect 50-100 ml of urine in a sterile centrifuge tube or urine specimen container. Please arrange for measles testing at a public health laboratory. If measles is suspected (complete infection control guidance at: http://tinyurl.com/lfpk3yn) Mask suspect measles patients immediately. If a surgical mask cannot be tolerated, other practical means of source containment should be implemented (e.g., place a blanket loosely over the heads of infants and young children suspected to have measles when they are in the waiting room or other common areas). Do not allow suspect measles patients to remain in the waiting area or other common areas; isolate them immediately in an airborne infection isolation room if one is available. If such a room is not available, place patient in a private room with the door closed. For additional infection control information, please see the CDC “Guideline for Isolation Precautions” at: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html If possible, allow only healthcare personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the patient’s room. Regardless of immune status, all healthcare personnel entering the patient room should use respiratory protection at least as effective as an N95 respirator per CalOSHA requirements. If possible, do not allow susceptible visitors in the patient room. Depending on the number of air changes per hour (see information in link above), do not use the examination room for up to one hour after the possibly infectious patient leaves. If possible, schedule suspect measles patients at the end of the day. Notify any location where the patient is being referred for additional clinical evaluation or laboratory testing about the patient’s suspect measles status and do not refer suspect measles patients to other locations unless appropriate infection control measures can be implemented at those locations. Instruct suspect measles patients and exposed persons to inform all healthcare providers of the possibility of measles prior to entering a healthcare facility so that appropriate infection control precautions can be implemented. Make note of the staff and other patients who were in the area during the time the suspect measles patient was in the facility and for one hour after the suspect measles patient left. If measles is confirmed in the suspect measles patient, exposed people will need to be assessed for measles immunity. Immunize them before they go Un- or under-vaccinated Californians who are traveling to countries where measles is circulating should receive MMR vaccine before they go. Infants traveling to these countries can be vaccinated as young as six months of age (though they should also have the two standard doses of MMR vaccine after their first birthday). Post flyers in your clinic Visiting another Country Flyer English Visiting another Country Flyer Tagalog Attention: You Could Have Measles poster Measles Alert flyer (for providers) Thank you for your continued efforts to protect the health of Californians. January 14, 2015 General Public Health, Measles 0 0 Comment Read More »
Health Advisory - Measles Update - April 2, 2014 Maxwell Ohikhuare, M.D., Health Officer, County of San Bernardino Measles Update: 49 Measles Cases in the State of California in 2014 Look for Signs of this Highly Contagious Disease Measles activity continues to be high in California this year. As of March 27, 2014, 49 confirmed measles cases with onset in 2014 had been reported to California Department of Public Health. In 2013, four measles cases had been reported by this date. Among the 2014 cases, 11 patients had traveled outside of North and South America with travel to the Philippines (n=8), India (n=2), or Vietnam (n=1). Of the patients without international travel, 30 had contact with known measles cases, 3 had contact with international travelers and 5 are under investigation to identify potential sources. Measles cases have occurred in both Northern and Southern California; however, the majority of cases are in Southern California (40/49). Several large contact investigations are ongoing. Cases range in age from 5 months to 60 years. Of the 29 measles cases for whom vaccination records are available: 22 were unvaccinated (16 were intentionally unvaccinated, 3 were too young to be vaccinated, 3 were not vaccinated for unknown reasons), and seven had received appropriate vaccination. Immunization data collection is ongoing and vaccination status is preliminary. Transmission has occurred in the following settings: households, urgent care clinics, physician offices, hospitals, churches and schools. There are 10 independent measles transmission chains. Four originated from imported cases (Philippines, n=4), two from cases who had contact with international travelers and four from cases with unknown source. A large measles outbreak is ongoing in the Philippines with over 15,000 cases in 2014, but measles is also circulating in many other countries outside of North and South America. Updated measles case numbers are posted each Friday on the CDPH website at: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Measles.aspx To prevent additional measles cases, California healthcare providers are recommended to: Immunize them before they go Un- or under-vaccinated Californians who are traveling to countries where measles is circulating should receive MMR vaccine before they go. Infants traveling to these countries can be vaccinated as young as six months of age (though they should also have the two standard doses of MMR vaccine after their first birthday). Remember the diagnosis The recent cases in California highlight the need for healthcare professionals to be vigilant about measles. Your expert eye, diagnostic skills, and prompt reporting of suspect measles patients to public health can make a difference in stopping the spread of this highly contagious disease in your community: Consider measles in patients of any age who have a fever AND a rash regardless of their travel history. Fever can spike as high as 105°F. Measles rashes are red, blotchy and maculopapular and typically start on the hairline and face and then spread downwards to the rest of the body. Obtain a thorough history on such patients, including: Travel outside of North or South America or contact with international travelers (including transit through an international airport and or other international tourist attractions) in the prior three weeks. However, since measles importations have occurred throughout California undetected community transmission cannot be ruled out; and Prior immunization for measles. Please note that although documentation of receipt of two doses of MMR vaccine or a prior positive measles IgG test result makes the diagnosis of measles less likely, measles can still occur in such persons. If you suspect your patient may have measles, isolate the patient immediately (see below) and alert your local health department as soon as possible. The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately. Post-exposure prophylaxis can be administered to contacts within 72 hours of exposure (MMR vaccine) or up to 6 days after exposure (Immune globulin - intramuscular). Please consult with your local health jurisdiction regarding appropriate administration. Collect specimens for measles testing: Draw 7-10 ml blood in a red-top or serum separator tube; spin down serum if possible. NOTE: capillary blood (approximately 3 capillary tubes to yield 100 µl of serum) may be collected in situations where venipuncture is not preferred, such as for children <1 year of age. Obtain a throat or nasopharyngeal swab; use a viral culturette and place into viral transport media. Collect 50-100 ml of urine in a sterile centrifuge tube or urine specimen container. Please arrange for measles testing at a public health laboratory. If measles is suspected (complete infection control guidance at: http://tinyurl.com/lfpk3yn) Mask suspect measles patients immediately. If a surgical mask cannot be tolerated, other practical means of source containment should be implemented (e.g., place a blanket loosely over the heads of infants and young children suspected to have measles when they are in the waiting room or other common areas). Do not allow suspect measles patients to remain in the waiting area or other common areas; isolate them immediately in an airborne infection isolation room if one is available. If such a room is not available, place patient in a private room with the door closed. For additional infection control information, please see the CDC “Guideline for Isolation Precautions” at: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html If possible, allow only healthcare personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the patient’s room. Regardless of immune status, all healthcare personnel entering the patient room should use respiratory protection at least as effective as an N95 respirator per CalOSHA requirements. If possible, do not allow susceptible visitors in the patient room. Depending on the number of air changes per hour (see information in link above), do not use the examination room for up to one hour after the possibly infectious patient leaves. If possible, schedule suspect measles patients at the end of the day. Notify any location where the patient is being referred for additional clinical evaluation or laboratory testing about the patient’s suspect measles status and do not refer suspect measles patients to other locations unless appropriate infection control measures can be implemented at those locations. Instruct suspect measles patients and exposed persons to inform all healthcare providers of the possibility of measles prior to entering a healthcare facility so that appropriate infection control precautions can be implemented. Make note of the staff and other patients who were in the area during the time the suspect measles patient was in the facility and for one hour after the suspect measles patient left. If measles is confirmed in the suspect measles patient, exposed people will need to be assessed for measles immunity. Post flyers in your clinic Visiting another Country Flyer English Visiting another Country Flyer Tagalog Attention: You Could Have Measles poster Measles Alert flyer (for providers) April 4, 2014 General Health Advisory, Public Health, Measles 0 0 Comment Read More »
