2-12 measles cocooningThe measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”

There is no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:

We hold dear both freedom of choice and public health.

Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.

Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine-preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.

That being said, you shouldn’t have to be afraid to run to the grocery store with your infant because of a measles outbreak. I’ve already touched on several tips for dealing with this outbreak if you have a baby at home, but what about when it’s your unvaccinated friends and family members who make you nervous?  How to do you broach a potentially awkward situation, keeping your child’s health at the forefront of the conversation? A few quick ideas…

3 Tips On Asking About Immunizations

  • Use age to your advantage. If grandparents were born in the United Staes before 1957 they are considered immune as the infection was widespread and nearly universal. If born after 1957 (the year vaccines became universal) there’s a good chance they could use an MMR booster if no proven immunity (having the shot, having had a documented case of measles). Advise them to check in with their doctor about getting a MMR shot if any questions. Here’s the CDC page that explains indication for an MMR shot. (*this paragraph edited for clarity on Feb 14 thanks to a helpful question/comment from Sarah!)
  • Write an email. In a past post, I gave an example email a friend drafted when her baby was born during the pertussis (whooping cough) epidemic of 2012. Her original included a request for both up-to-date flu and Tdap vaccination, and it’s a great template for any new parent (see below.)

Hi there,

We are hoping we get to see you and introduce you to our new baby sometime in the next few months!

Due to the (insert disease outbreak), I am being a stickler about only having visitors who have had (insert vaccine here).  We just got back from our doctor who emphasized how important this is as this disease is very serious for infants. A (vaccine) should be completed 2 weeks before hanging out with a newborn.

You can get both at your doctor’s office and at many pharmacies that do vaccines. Thanks for understanding!

  • MMR isn’t the only shot that matters. Take the time to ask that all vaccinations are up to date. This includes Tdap (for whooping cough which is especially dangerous for infants) and the flu vaccine (influenza is also more dangerous for infants).
  • Don’t forget about the babysitter. It’s okay to ask if your teenage sitter is up-to-date on his/her immunizations. The same goes for your day care provider. A recent report looked at New Jersey, Connecticut and New York City, all of which have mandatory flu vaccination requirements for children enrolled in preschool or day care centers. Some key findings:
    • In 2012, New Jersey’s 88.0% vaccination coverage in children age four years and younger was 18.0 percentage points above the national average.
    • 2-12 CT vaccination rates.pptxConnecticut saw a jump in vaccination rates from 67.8% in 2008 to 84.1% in 2012.
    • New York City’s regulation began in January of 2014, so there is no data available yet, but the city’s goal is a coverage rate of 90.0% or higher.