Caring for Patients: Vaccine Preventable Diseases

My son and several friends developed chicken pox. It was a just before the vaccine was approved for widespread use  and became part of the routine immunization schedule. He developed mesenteric adenitis and for a few hours I held him as he cried in severe pain. A dose of Tylenol finally kicked in. I knew what it was but it was frightening watching him. That year several children died from an invasive streptococcal infection. One of them was a patient. We always feared the complication of Reyes Syndrome but not cellulite or pneumonia due to this invasive bacteria was a surprise.  There were cases from California to New York.

It is not widely known but we are having a resurgence of vaccine preventable diseases in the US. It is happening in many states. There are cases of measles and mumps in California, New Jersey, New York, Ohio and Texas. From January 1 through May 23, 2014 a total of 288 confirmed measles cases have been reported surpassing the highest reported yearly total of measles cases since elimination which was 220 in 2011. We are losing the advantage of herd-immunity because many are choosing not to be vaccinated. The vaccines are not a hundred per cent effective. Many of those immunized do not develop full immunity after vaccination. Thanks to several recently written news articles and television news reports, the alarm is being sounded. We need to be more vigilant. The CDC reports that 280 (97%) of the cases were associated with importation of measles from at least 18 countries.

I found out in medical school I lacked immunity to Mumps. I received a single dose of the vaccine. I remember having both measles and chicken pox along with my sisters and cousins. We were all home from school. Now, I always show immunity when I get blood tests.

My son went to Buenos Aires when he was 11 for a program so he was immunized against Hepatitis A. I remember the Hepatitis A outbreak in my area in the 90’s. I had patients coming in to get blood work. We worked with the local Health Department and they got the Immune globulin. I had my son get the Meningitis vaccine when he was in college even though he was commuting.  I am a believer in immunizations. I am concerned that I should have him tested for immunity to measles, mumps and rubella. There are some patients that do not develop immunity even with adequate vaccination. I may be overly concerned.

I have the responsibility of enforcing the university immunization policy and it is not an easy task. This year I increased the requirements. Many students don’t think it is important. Many doctors also fail to follow the immunization schedules and vaccinate their patients. So I have to take on the role, to insure we have no campus outbreaks. With two cases of chicken pox, I had double work. I had to notify students, get them tested for immunity and those not immune had to be vaccinated. I really do not want a repeat of this.  So, I am hoping my new Electronic Health Record will help me improve compliance.

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