The North Dakota Nurse - July 2022

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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.
July, August, September 2022 The North Dakota Nurse Page 21 If you have not yet received your MMR vaccines yet, now is a great time to do so! If you fall into one of the following populations you may want to consider MMR or MMRV vaccination: • If you were born in 1957 or later and have not had the MMR vaccine, or if you don’t have a blood test that shows you are immune to measles or mumps (i.e., no serologic evidence of immunity or prior vaccination) • Health care workers born before 1957 who lack laboratory evidence of immunity or laboratory confirmation of disease. Nurses without presumptive evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days. The MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. • MMR Vaccine (Measles, Mumps, and Rubella Vaccine) | Oxford Vaccine Group North Dakota Data • Coverage Rates | Department of Health (nd.gov) Related Articles • UNICEF and WHO warn of perfect storm of conditions for measles outbreaks, affecting children • Herd Immunity: Will We Ever Get There? Yale Medicine • Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2020–21 School Year | CDC MMWR • Subacute Sclerosing Panencephalitis | NIH How can I address vaccine hesitancy among my patients? We can all agree that it is important for health care providers, including nurses, to have conversations about the benefits of immunizations with their patients. Today however, having those conversations regarding the importance of routine immunizations can be uncomfortable at times. Especially if you do not feel equipped with the communication skills needed to diffuse vaccine misinformation your patients may have found online. Below are strategies you can use to help you feel more confident recommending vaccines to your vaccine hesitant patients. • Know your patient’s vaccination status before their appointment. • Respectfully address your patient’s vaccine concerns by practicing empathy and active listening without being judgmental. • Use presumptive language with your patients. - Example: “Your child needs their MMR, varicella, and pneumococcal vaccines today.” versus “What do you want to do about your child’s shots that they are due for today?” • Do your part in building patient-provider trust at all medical encounters, including non-vaccine related appointments. Your recommendation matters. YOU play an essential role in promoting and building trust in vaccinations. Nurses are consistently found to be one of the most trusted professions in our country. It is important to provide patients with high quality, evidence-based information regarding their vaccine-related questions. Before considering vaccine information on the internet, check that the information comes from a credible source and is updated on a regular basis. While the internet is a useful tool for researching health-related issues, it should not replace a discussion with a health care professional. Clear and consistent messaging across all levels of health care needs to be followed in order for patients to feel safe and prepared to get themselves and their families immunized. Research has shown that vaccine-hesitant individuals became less hesitant after a brief recommendation from a health care professional. It is important that all nurses in North Dakota offer a strong recommendation to vaccinate against measles to all vaccine eligible patients ages 12 months and older. For more information, please consider checking out the following resources: General Information • Measles, Mumps, and Rubella (MMR) Vaccination | CDC • Vaccination Is the Best Protection Against Measles | FDA • Measles (Rubeola) For Healthcare Providers | CDC • Global Measles Outbreaks (cdc.gov) Addressing Vaccine Hesitancy • How to Have Productive Vaccine Conversations: Moving the Needle Toward Vaccine Acceptance - NDSU CIRE YouTube Measles Complications NDC3 is improving health and wellness in communities across North Dakota Through a network of local leaders, community organizations and health systems, NDC3 delivers programs to help individuals manage chronic health conditions, prevent falls, and foster well-being. If you are coping with high blood pressure, heart disease, COPD, arthritis, diabetes or other chronic conditions, NDC3 can support your efforts to live life as fully and independently as possible. Better Choices, Better Health: Diabetes (online) Aug. 16, 2022 - Sept. 20, 2022 3:00 PM - 5:30 PM See All Dates Cost: $0 Contact Name: Amanda H Contact Email: bcbh@sanfordhealth.org Contact Phone: 701-417-4905 People with type 2 diabetes attend the class in groups of 12-16. Participants will make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program. Physicians, diabetes educators, dietitians, and other health professionals both at Stanford and in the community, have reviewed all materials in the class. This "virtual" class will be held via Zoom. Don't know how to use Zoom? Don't worry we will help you! All participants must have audio and visual technology to participate. Diabetes Prevention Program Aug. 23, 2022 - Aug. 15, 2023 5:15 PM - 6:15 PM See All Dates Cass County Annex Building 1010 2nd Ave. S Fargo, ND 58103 Cost: $0 Contact Name: Rita Ussatis Contact Email: Rita.Ussatis@ndsu.edu Contact Phone: 701-241-5700 National Diabetes Prevention Program (NDPP) is a collaborative, community-based, lifestyle change program designed for people with pre-diabetes. It is based on the Centers for Disease Control and Prevention’s curriculum and National Diabetes Prevention Recognition standards. This class is 24 sessions, The first 12 classes will be weekly, followed by 4 biweekly class and then monthly for the 1 year duration. Melissa Kainz, DNP, MSN, RN, Community Clinical Coordinator, Division of Health Promotion 701-328-4568 | mkainz@nd.gov NDC3.org
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