by Tia Will
Robbie Pearl is the CEO of The Permanente Medical Group. As such he is responsible for the provision of medical care to the 3.6 million people insured by Kaiser Permanente in Northern California. He writes a monthly column for Forbes. In the February 5th issue, his commentary started as follows :
“My father’s sister Mary died from measles when she was 6 years old. Her death haunted my grandparents for the rest of their lives.
She was one of thousands who died each year from measles before there was a vaccine to prevent this life-threatening disease.”
He then proceeds to lay out a very concise review of the history of measles, the discovery of an effective vaccine, the origins of the anti vaccination movement and makes a plea for vaccination as the most effective tool we have to stop illness and deaths related to this serious and highly infectious disease. I highly recommend his piece to anyone interested in this topic.
From January 1 st – February 6th there were 121 reported cases of measles in 17 states with 88 of these cases in California. Standard epidemiological case tracking and DNA testing have confirmed that most of these cases are linked either directly or as “second wave” to exposure at Disneyland and that this particular strain of the measles was imported from the Philippines.
My purpose in reintroducing this topic is to discuss the scope of this issue as it affects us here in Yolo County and what steps are currently being taken to minimize the risk. I will first present some information regarding measles and immunization in our county.
As of Thursday there were no reported cases of measles in Yolo County. Does this mean that we are safe, or have dodged a bullet, or are immune as a community in Davis ? Not necessarily. Measles, being an airborne pathogen is passed in waves. It can be carried by an individual who typically has a pro-drome of 3-4 days prior to outbreak of rash consisting of a low grade temperature elevation with runny nose and sneezing or coughing and can thus pass the disease on to many others before recognizing that what they have is a highly contagious and in some cases life threatening illness. The virus which causes measles is capable of lingering suspended in the air and in microscopic fluid droplets on surfaces for at least two hours after being expelled. Thus it is possible to transmit the virus without ever having had direct contact or even being in the same room at the same time with the recipient. It is our historical high rate of vaccination that has protected us until recently. However, with strengthening of the anti-vaccination movement there has been a decrease in the number of parents choosing to vaccinate their children. This decrease has not occurred uniformly throughout the area, but rather in pockets.
According to statistics gathered by the Yolo County Health Department for the 2013-2014 school year, the distribution of immunizations as reported by the local schools was as follows :
92% of entering kindergarteners were immunized
4% had personal belief exemptions
93 % of public school students were immunized
98 % of Woodland students were immunized
85 % of West Sac students were immunized
75 % of private school students were immunized
51% of Davis Waldorf students were immunized
Despite our access to efficient health care delivery systems here in Davis, we have one of the highest rates of non vaccination, and thus one of the highest rates of risk to those in our community who are not eligible for vaccination. In a recent conversation with a parent in our community who has two children not eligible for vaccination I learned that he is afraid to take his children out to public events such as the Davis Farmer’s Market for fear of exposure. His fear is not unfounded.
While there are risks involved in all medical interventions including vaccination, it is critical to look at the risks of the intervention in comparison with the risks of the disease. Robbie Pearl described the relative risks this way :
“The measles vaccine is proven safe and effective. The risk of experiencing a major problem from the vaccine is roughly less than 1 in 40,000. In contrast, studies show 1 in roughly every 333 people who contract measles will die from it.
While the perception that there is no need to vaccinate may have had some basis when it appeared that measles had been virtually eradicated in the United States, that is no longer true. Measles is again with us as this current outbreak has demonstrated . From the point of view of a primary care doctor, there is no longer any justification to not immunize any individual who does not have a medical contraindication and who choses to participate in the activities of the community thus putting the community at risk.
I chose to build my career with Kaiser over the past 27 years largely because of the shared philosophy in the group of the importance of primary prevention as invariably superior to treatment once a disease condition has developed. It is with this philosophy in mind that Kaiser has instituted the following steps to protect the health of our members and our community :
- Universal pediatric screening of all patients for currency of their immunization status
- Strong recommendation to parents to make up for any disparity from current pediatric recommendation.
- Physician outreach to parents of children who are not fully immunized in the form of telephone calls and secure ( HIPPA compliant) emails.
- Screening questions designed to identify patients calling who may be demonstrating symptoms of measles in much the same way as we used screening questions to identify patients who might have been exposed to Ebola prior to their arrival at our facilities.
- Strict isolation protocols for any patient arriving at our facilities with symptoms suggestive of the measles.
- Strict decontamination protocols for any room in which a measles patient may have been.
So far, we have been lucky. There are no reported cases of the measles in either Davis or Yolo County. As a front line primary care provider, it is my goal to keep it that way. We all have a role to play in ensuring that our community remains free of this potentially devastating disease. My recommendation for each adult individual is the following :
- Know your own immunization status – if in doubt, consult with your doctor.
- Know the immunization status of your children. If you have not, please reconsider immunizing your children in light of the current outbreak.
- If you choose not to immunize your children, please consider keeping them out of public contact. The life that you save might be that of a stranger than you do not even know that you have affected, but it could equally well be the life of your own child.
- Talk about this issue with your family members and friends. Listen to concerns with respect and recommend that all to whom you talk give consideration to all of the issues involved, not just one specific fear.
- Be proactive. Don’t hesitate to engage in conversations about this issue. We all have much at stake in the protection of our lives, those dear to us, and the protection of the entire community from this life threatening illness which we have the ability to completely eradicate if all who are medically eligible were to receive vaccination.