The North Dakota Nurse - July 2022

Page 20 The North Dakota Nurse July, August, September 2022
Answering Your Questions on Vaccines
MMR Vaccination: Protecting the Public
and Nurses Against Measles
Jessica Allen, Immunization Health Educator,
North Dakota Department of Health
Did you know, two doses of the MMR
(measles, mumps, and rubella) vaccine is
97% effective at preventing measles? MMR
vaccination plays an important part in keeping
you and your community safe from measles.
Here’s what you need to know about measles
and the MMR vaccine!
In April of 2022, the World Health
Organization (WHO) and the United Nations
International Children’s Emergency Fund
(UNICEF) announced that in the first two months
of 2022, global cases of measles had increased
by 79% when compared to that same time
period last year. These agencies and public
health officials across the planet are concerned
that this could trigger larger measles outbreaks
that may impact millions of children in 2022.
Fortunately, measles is a vaccine-preventable
illness, with two doses of the MMR (measles,
mumps, and rubella) vaccine being 97%
effective at preventing measles. However,
vaccination rates around the world have
substantially decreased during the COVID-19
pandemic. In fact, it is estimated that 23 million
children missed out on routine immunizations
through routine wellness visits during 2020,
the highest number since 2009. Disruptions in
routine wellness visits and vaccinations among
pediatric populations has ultimately left us all
increasingly vulnerable to a measles outbreak.
What are North Dakota’s current MMR
vaccination coverage rates?
In North Dakota, MMR vaccination rates
amongst North Dakota infants aged 19-35
months decreased more than 6%, from 84.7%
in December 2019 to 78.3% in December
2021. Additionally, kindergarten-entry MMR
vaccination rates decreased from 94.75%
during the 2019-2020 school year to 92.36%
during the 2021-2022 school year. A reduction
in vaccination coverage can lead to pockets
of un- or under-immunized children across
the state, which lowers our state and local
community’s herd immunity against the
measles virus. Herd immunity, also known as
community immunity, refers to the term in
which a certain threshold of the population
is immune to an infectious disease. As a result,
the infectious disease is no longer able to easily
spread and infect those who are not immune.
Herd immunity against measles is crucial for
keeping all of us, especially those who are
immunocompromised and infants too young
to be vaccinated, safe from inadvertently
contracting measles from the unvaccinated.
Nationally for the 2020-2021 school year,
vaccination coverage rates for all required
vaccines was approximately 1% lower than
that of the previous year. Only 93.9% of children
entering kindergarten in the United States
were vaccinated with two doses of the MMR
vaccine. While a 93% vaccination coverage
rate for measles may not sound concerning to
most people, it is quite concerning to public
health officials. According to Yale Medicine,
“the percentage of the population that needs
to be immune to attain herd immunity varies
by disease and how contagious that disease
is. Measles, for example, spreads so easily that
an estimated 95% of a population needs to be
vaccinated to achieve herd immunity. In turn,
the remaining 5% have protection because, at
95% coverage, measles will no longer spread.”
Once an individual is vaccinated against
measles, they are considered immune for life.
Kindergarteners are our next generation of
North Dakotans, which is why it is important
that all those who are eligible be vaccinated
against measles in order to continue to keep
our communities safe into the future.
What is measles, who is at risk, and what are the
side effects?
Measles is caused by a single stranded RNA
virus with only 1 serotype (for reference there
are over 90 serotypes of the pneumococcal
bacteria). This virus falls under the family of
other Paramyxoviridae viruses and the only
known host of this virus is humans. Measles is
transmitted from person to person through
direct contact of infected droplets or through
airborne transmission when an infected person
sneezes, coughs, or breathes. Measles is a highly
contagious virus. In fact, 90% of unprotected
(un- or under vaccinated) people who come
into contact with an infected person will
consequently become infected with measles as
well.
Measles is typically characterized by
a maculopapular rash (a type of rash
characterized by a flat, red area on the skin
that is covered with small confluent bumps),
usually developing within 14 days following
exposure and spreading from the patient’s
head down through their trunk and lower
extremities. Please note that sometimes
immunocompromised patients will not develop
a rash. Other commonly reported side effects
include ear infections and diarrhea.
Even children who were previously healthy
can become severely ill from an infection due
to measles and may require hospitalization.
Here are some quick facts on the seriousness
of this disease and the complications you and
your patients could expect if they were to
become ill:
• One out of five unvaccinated people in the
United States who get measles will require
hospitalization.
• An estimated one out of every 20 children
infected with measles will develop
pneumonia, the most common cause of
death for children with measles.
• Approximately one out of every 1,000
children infected with measles will
develop encephalitis, that could lead to
convulsions and leave a child permanently
disabled or deaf.
• Nearly one to three out of every 1,000
children who are infected with measles will
die.
Measles can be a serious illness among
any age group. However, there are several
populations that are at a particularly higher
risk for severe complications. Those populations
include children younger than the age of
five years, adults over the age of 20 years,
individuals who are pregnant, and those who
are immunocompromised.
Are there any long-term complications
associated with measles?
Yes, there are potential long-term
complications that can follow a prior infection
with the measles virus. Subacute sclerosing
panencephalitis (SSPE) is a very rare, but fatal
disease of the central nervous system that
results from a measles viral infection acquired
earlier in life. While SSPE is rarely reported in the
United States, patients who survived measles
during early childhood, specifically before
the age of two years old, are at an increased
risk of developing this condition generally
seven to ten years later. Patients who develop
SSPE may experience a slow progression of
symptoms including mild mental deterioration,
memory loss, changes in behavior and mobility
impairment. Over a period of months to
potentially years, many patients proceed to
generalized convulsions, dementia, coma, and
death.
Vaccine hesitant parents of your pediatric
patients who are due for their MMR vaccination
may not know about SSPE. They also may not
know about SSPE’s potentially life-threatening
complications later in life if their unvaccinated
child does end up contracting measles. You
can help your community maintain high
levels of herd immunity by encouraging and
educating your patients and their parents on
the benefits of MMR vaccination as well as the
risks associated with measles infection. Because
preventing measles also means protecting
against measles induced SSPE later in life. For
more information on SSPE, check out this video
or visit the NIH’s website.
If measles is an eliminated disease in the United
States, how come we continue to see cases?
In 2000 the United States declared measles
an eliminated disease. Meaning the country
had become free of infections. However, there
were nearly 1,300 cases of measles reported
in the year 2019. The measles outbreaks that
occurred during 2019 in the U.S. were all
linked to infected travelers that had entered
communities with high-risk populations of un- or
under vaccinated people. These communities
did not mount the herd immunity needed to
prevent an outbreak of measles. So, while
measles is an eliminated disease, ultimately the
next measles outbreak may only be just one
plane ride away.
With many North Dakotans considering
returning back to their pre-pandemic
international travel plans, we can expect
that some individuals may begin traveling
to areas of the world, including African and
Eastern Mediterranean regions, where measles
outbreaks continue to persist. The risk of
bringing measles back into the state of North
Dakota through international travel puts several
of our communities who have higher levels of
un- or under vaccinated residents at greater risk
of potential measles outbreaks.
What is the recommended vaccination
schedule for the MMR vaccine?
The CDC’s Advisory Committee on
Immunization Practices (ACIP) recommends
that those without presumptive evidence of
immunity against measles be vaccinated with
either the MMR or the MMRV (measles, mumps,
rubella, and varicella) vaccine.
CDC recommends two doses of a measlescontaining
vaccine routinely for children,
starting with the first dose at age 12 through
15 months and the second dose at age four
through six years. Adults should also be up to
date on MMR vaccinations with either one or
two doses (depending on risk factors) unless
they have other presumptive evidence of
immunity to measles. Providers generally do
not need to actively screen adult patients for
measles immunity in non-outbreak areas of the
United States.
There are situations in which special
populations may be recommended to be
vaccinated against measles. Additionally,
individuals who may have missed their routine
immunizations are encouraged to catch up
on their vaccines. For more information on
vaccinating these populations, please visit the
CDC’s immunization schedules.
Do nurses need to be revaccinated against
measles?
Once an individual is vaccinated against
measles or has recovered from a prior
infection of measles, they are considered to
be immune for life. Oftentimes, health care
workers including nurses are at an increased
risk for exposure to serious, and sometimes
deadly, diseases. If you work directly with
patients or handle material that could spread
measles infection, you should get appropriate
vaccinations to reduce the chance that you will
get or spread this vaccine-preventable disease.