Telluride Med Center: Urging Parents to Vaccinate Children

07 Feb Telluride Med Center: Urging Parents to Vaccinate Children

Colorado children have lowest vaccination rate in U.S.

Dr. Sharon Grundy. Medical Director of Primary Care, Telluride Medical Center

Colorado kindergartners have the lowest vaccination rate for measles in the U.S., an unsettling distinction that has providers at the Telluride Medical Center (TMC) working to clarify who is at risk and who needs to be vaccinated.

“Basically, if you’ve been immunized or have had the measles before, you’re protected from contracting or carrying the virus. If you or your child has not been vaccinated, we want to hear from you,” said Medical Director of Primary Care at TMC, Dr. Sharon Grundy. “The more our population is vaccinated, the better we can protect those too young to have been immunized, people with compromised immune systems and unvaccinated pregnant women.”

The recent measles outbreak has raised serious concerns from health professionals that the virus could once again gain a foothold in the U.S. “Communities with low vaccination rates are at particular risk,” said Dr. Grundy.

Prior to 1963, when the vaccination was released to the public, 3 – 4 million cases of measles, a virus of the paramyxouvirus family, were reported in the U.S. each year. According to the Centers for Disease Control and Prevention (CDC), 90 percent of the population had contracted measles by the age 15.

In 2004 the U.S. had only 37 reported cases of the virus, the least on record. On average, since 2001, the U.S. records 67 cases a year. Due to the recent outbreak stemming from California, over 100 measles cases have been reported in 14 states, including at least one in Colorado.

The threat of a serious rise in measles cases is real. Colorado is one of 20 states that allow parents to claim personal opposition to immunization programs. According to the CDC, only 81 percent of Colorado students entering kindergarten last year had received both their MMR (measles-mumps-rubella) vaccinations. Most states have rates of 95 percent and 17 states report less than 90 percent of children having received at least one dose.

France experienced a rapid increase of measles infection rates peaking in 2011 at over 10,000 cases, up from only 40 in 2008.

In some cases, children with measles can develop pneumonia or encephalitis (an infection of the brain). The World Health Organization estimated 20 million people a year get the measles and reported 145,700 deaths due to measles in 2013, most were children under the age of five. More than 95 percent of these deaths occurred in countries with weak health care infrastructure particularly in parts of Africa and Asia.

“We’re lucky, there is a vaccination and it’s highly effective. This isn’t something we have to live with like other generations of Americans did before us,” said Dr. Grundy.

The MMR vaccine is considered one of the most beneficial vaccinations released in the last century.

Measles vaccination resulted in a 75 percent drop in measles deaths between 2000 and 2013 worldwide. In 2013, about 84 percent of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73 percent in 2000.

Measles spreads readily when it reaches a community in the U.S. where groups of people are unvaccinated. If exposed, and unvaccinated, the infection rate is as high at 90%. Children and pregnant women take on the highest risk of complications.

Those who have received both vaccine doses are protected up to 99 percent and even just the first dose can protect up to 90 percent against infection.

The first dose of the MMR vaccination is recommended at age one and the second dose between ages 4 – 6.

Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa. Most domestic outbreaks are caused by travelers, specifically unvaccinated Americans, who come home from other locales infected with measles.

Prevention is key. Herd immunity calls for a push to vaccinate as many as people as possible. When immunization rates are very high, the community as a whole benefits as vaccinated people act as a barrier and reduce the risk of infection for the very young or those with compromised immune systems. Immunized adults contribute to the herd immunity, though some adult’s immune status is unknown.

Americans born before 1957 may not have received that vaccination however most likely had the disease in childhood and are considered immunized since measles can only be contracted once in a lifetime.

The MMR vaccination was released in 1963. A version of the measles vaccinations called an attenuated (killed) vaccination was given from 1963-1967, which may not have conferred lifetime immunity. “It’s possible segments of baby boomers may need to obtain a booster or have immunity status checked with a simple blood test,” said Dr. Grundy.

Symptoms

Measles signs and symptoms appear 10 – 14 days and up to 21 days after exposure to the virus. Signs and symptoms of measles typically include:

• Fever
• Dry cough
• Runny nose
• Sore throat
• Inflamed eyes (conjunctivitis)
• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek – also called Koplik’s spots
• A skin rash made up of large, flat blotches that often flow into one another

The Stages (two – three weeks) of Measles:

• Infection and incubation. For the first 10 – 14 days after being infected, the measles virus incubates. There are no symptoms during this time.
• Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.
• Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline.
• Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.
• Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days

You can contract measles just by being in the same room as a person with measles even if that person left the room; the virus can hang around for a couple of hours. This increases the risk of the disease in communities and in schools.

Treatment of measles is supportive; meaning the goal of the care is to help manage symptoms rather than the underlying cause of the disease.

TMC recommendations:

• Vaccinate your child with the MMR vaccination. First dose can be given at age one and a second between ages 4 – 6.
• If your child did not receive the vaccination, no matter what age, they should receive the vaccination now.
• Anyone who travels outside the U.S. is at high risk and should be vaccinated.
• Adults with unknown vaccination status can set up an appointment for a lab test to check immunity or receive an MMR booster. There is no harm in getting a booster dose.
• If you have a child or yourself have not been vaccinated and develop symptoms, please contact TMC by phone. TMC will need to take precautions with your visit. Those who are immunized are protected.
• Respiratory masks are available at TMC’s front desk; if you are a vulnerable patient or are unvaccinated and have symptoms please request a mask to protect yourself and others.

“The important thing is that we have enough immunized people in our community to create a barrier to protect the super young, sick and pregnant,” said Dr. Grundy.