Measles, other infectious diseases likely to return without vaccine adherence

Issue: January 2016

NEW YORK — Without continued vaccination efforts, infectious diseases such as measles, are likely to return to the United States and become serious public health concerns, according to a presentation at the 2015 Infectious Diseases in Children Symposium.

While prevention is vital to the eradication of vaccine-preventable diseases, recognition and management skills are equally as important for pediatricians when they are presented with a rare case, according to Margaret C. Fisher, MD, medical director of the Unterberg Children’s Hospital at Monmouth Medical Center in New Jersey.

Margaret C. Fisher

Fisher said infectious diseases such as Haemophilus influenzae, pneumococcal disease and diphtheria are not likely to return, but could regain a foothold in the U.S. without sustained vaccine adherence. She said pertussis, mumps and measles currently have the greatest likelihood of an outbreak.

Measles is highly contagious and easily transmitted in populated groups of people, such as the Disneyland outbreak in California that originated in December 2014 and extended into this year, according to Fisher.

“Measles is transmitted by droplets, and it is truly airborne,” Fisher said. “We always talk and worry about the air, but this is one of the times when you actually do have to worry about the air and recirculation of the air.”

According to Fisher, measles is characterized by a confluent rash, which can appear across the body, making diagnosis very apparent. This rash, however, does not appear until after the disease has been contagious for a significant period of time, increasing the likelihood of transmission.

“A patient is contagious before they get the characteristic rash,” Fisher said. “They are contagious during the first 8 to 12 days, during the fever and conjunctivitis phase, where you can’t make the diagnosis of measles unless you knew there was an exposure.”

According to research cited by Fisher, in 2014 there were 23 outbreaks of measles with more than 600 cases. This year there have been five outbreaks with 188 cases, mostly due to imported cases.

“The United States was declared measles-free in 2000,” Fisher said. “But look what has happened since becoming measles-free. The [designation of] measles-free is still true, but we have had many, many imported cases.”

Travelers are among the largest contributors to the threat of measles outbreaks, Fisher said.

“We know that U.S. travelers go to Europe where there is still lots of measles,” she said. “They get measles there, and they bring it home and spread it to their unvaccinated contacts — and we also know that travelers to the U.S. bring measles along.”

Fisher recommends that every health care worker be vaccinated with two doses of measles-mumps-rubella vaccine, to maintain infection control. Patients presenting with measles also must be isolated into an examination room and masked.

“Infection control is really essential,” Fisher said. “You really don’t want these patients in your office, because they can contaminate the air. If a child is in your office, then the entire office is considered contaminated for 2 hours after the patient leaves.”

According to Fisher, a single diagnosis of measles is considered an outbreak; therefore, after a clinical diagnosis is made, it should be confirmed with serology and reported to the local health department.

“It is important to know when there has been measles in the area,” Fisher said. “We have to be vigilant, and we have to make those diagnoses quicker.” – by David Costill

Reference:
Fisher MC. “Vaccine-Preventable Diseases That May Come Back.” Presented at: IDC NY; Nov. 21-22, 2015; New York.

Disclosure: Fisher reports no relevant financial disclosures.