We're experiencing the resurgence of measles, a disease that had been effectively eradicated in the United States due to herd immunity from population-wide adherence to vaccination against measles. What went wrong? A fraudulent study published in 1998 influenced significant numbers of parents to refuse vaccination for their children due to an unfounded belief that the measles-mumps-rubella vaccine causes autism.1 Though the study that spurred these fears has been expunged from the literature and the author severely sanctioned, the damage continues and represents an ever-growing threat to public health.
Educating the general public about health issues always poses significant challenges. That's why I'm amazed at how health misinformation can so readily proliferate and overpower legitimate, evidence-based science. Debunking the bunk becomes a task unto itself.
Should vaccination be mandatory as a critical matter of public protection? Consider this: Someone's choice not to vaccinate against measles and other serious diseases can directly lead to the morbidity and mortality of countless innocent people. These include babies too young to be immunized, individuals who can't receive vaccines due to immune system problems, and even people who were vaccinated long ago, because the earlier vaccines may no longer be fully protective.
Prevention isn't simply a matter of good hand hygiene and respiratory etiquette because measles isn't like the typical garden-variety viruses we've come to know—it's airborne and highly infective. In fact, measles can be transmitted to unsuspecting people who enter a room up to 2 hours after a person with measles has left the area. Waiting rooms and public gathering places become the hot zone. (For more on these risks, see Advice p.r.n. on page 12 and Combating Infection on page 62.)
The ill aren't necessarily easy to spot either. The telltale rash isn't present during the early illness prodrome, when patients experience flu-like symptoms—but patients are infectious up to 4 days before the rash appears. And despite advice to stay home when ill, many people continue their daily routines and spread infection along the way.
I certainly support individual self-determination for most aspects of healthcare because it's consistent with a patient-centered approach. But when it comes to highly contagious diseases that can harm many more lives than the individual's own, that philosophy changes. For these circumstances, it's past time that we shifted our direction to population-centered.
Until next time,
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2015 Vice President, Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.
1. Rao TS, Andrade C. The MMR vaccine and autism: sensation, refutation, retraction, and fraud. Indian J Psychiatry