The family physician's role in vaccine-preventable disease outbreaks

- Jennifer Middleton, MD, MPH

The Centers for Disease Control and Prevention (CDC) is monitoring 3 current measles outbreaks in the United States, and most of the affected individuals are children under the age of 10 who did not receive the measles, mumps, and rubella (MMR) vaccine. Infected travelers to the US appear to be the sources for these outbreaks, but the disease's spread after its arrival has primarily been due to under-vaccination. Reporting suspected cases, discussing vaccine hesitancy with caregivers, and optimizing our office vaccination processes are all tangible ways for family physicians to respond.

Coughing and sneezing spread the highly contagious measles virus, and individuals are infectious from 4 days prior to 4 days after the appearance of its pathognomonic rash. Measles infection complications include pneumonia, ear infections, permanent hearing loss, encephalitis, permanent brain injury, and death. Physicians who suspect a patient may have measles should promptly contact their local health department. Unfortunately, CDC data demonstrate that these current measles outbreaks in the US are nothing new. Pockets of under-vaccinated communities across the US have provided easy targets for measles' spread once it's introduced.

Increasing vaccination rates is a critical but challenging component of the solution. With vaccine hesitancy now among the World Health Organization's (WHO) top 10 threats to global health, it's critical that we redouble our efforts to combat the spread of misinformation about vaccines. Discussions with vaccine-hesitant parents in the office can feel futile, but family physicians should remember that their recommendation is the most common reason cited when parents do decide to vaccinate. Phrasing vaccine recommendations as statements instead of questions correlates with higher vaccination rates. Eliciting and responding to caregivers' specific concerns can also be useful.

Our office staff can work with us to reinforce these messages, too. This 2016 AFP Editorial on Strategies for Addressing and Overcoming Vaccine Hesitancy includes links to several additional resources. An FPM article on improving influenza vaccination rates includes office strategies relevant to all types of vaccinations. The WHO's Addressing Vaccine Hesitancy website provides "a guide for exploring health worker/caregiver interactions on immunization" along with an online training module on "conversations with hesitant caregivers."

In the face of these outbreaks, combating vaccine hesitancy remains as critical as ever. What strategies have you found useful?