Recent outbreaks of the Measles in the United States have sparked a discussion about the decision of some parents not to vaccinate their children against the disease.

Measles is a highly contagious virus transmitted primarily from person to person by large respiratory droplets (in addition to being aerosolized) up to four days before symptoms appear; allowing the disease to spread before a person even knows they are sick. The disease is diagnosed through serological tests for IgM antibodies to Rubeola and confirmatory PCR tests and viral cultures. The MMR (Measles, Mumps, and Rubella) vaccine, which protects against the illness, is required in all fifty states and Washington, DC for public school admission, but many allow exemptions for medical and religious reasons.

In 2000, Measles was declared eliminated in the US, largely due to the efficacy of the measles vaccine, which is 93-95% effective with just one dose, and at least 97% effective after two doses.  Ironically, that success of the vaccination seems to have resulted in a situation in which parents (and some physicians) have no memory of the devastating effects of the measles (and other diseases such as poliomyelitis and pertussis), making it more difficult for them to appreciate the benefits of immunization.

Most at risk with recent measles outbreaks are those who are immunocompromised, such as transplant patients, HIV patients, and those undergoing treatment for cancer.  But in addition to those who are unable to receive the vaccination, the children of these parents who choose not to vaccinate are also at a direct risk.

The vast majority of parents in the US immunize their children in accordance with nationally recommended vaccine schedules. While a small number of parents have proven impervious to information and education and refuse to vaccinate their children at all, …less than 1 percent of children in the US between 19 and 35 months of age are completely unvaccinated.

Physicians need to be prepared to discuss the risks associated with remaining unvaccinated and/or delaying certain vaccines, as well as take time to understand the parent’s reasons for resisting vaccination.  During these conversations physicians should be sure to:

  • Present information in a way that best supports informed decision-making, which ensures that parents have the necessary foundation for making sound decisions.
  • Direct parents to reputable, credible sources of information. The CDC, American Academy of Pediatrics and the American Academy of Family Physicians have created materials to help physicians help parents in making vaccination decisions for their children.
  • Inform parents about state immunization requirements pertaining to entry into school or childcare, which might require that unimmunized children remain at home during outbreaks of vaccine-preventable diseases

Parents may be more receptive to considering vaccination when they understand as physicians, we are primarily motivated by the welfare of the individual child rather than a broader public health goal.

The challenge for the health care community is to not further alienate individuals and groups who question vaccines, but to try and understand and address their concerns. Building public trust and restoring confidence through regular dialogue are critical to achieving sustained vaccine acceptance. Part of the responsibility of the healthcare community in this regard, is to aggressively counter the influence of misinformation spread by high profile individuals in the antivaccination movement.

As a physician, it is your job to help children and their parents. Be willing to have an open, honest and frank discussion with vaccine hesitant parents and their families to help create an understanding of the importance of vaccines. Parents should be putting their child in the safest position possible, and that’s what vaccines do.