Continued Vigilance is Required to Combat Vaccine-Preventable Disease and Deaths

Abstract

Welcome to JNP’s special issue on infectious diseases (IDs). In this issue you can read about many topics related to ID caused by all types of infectious agents; a few of these can be prevented or significantly attenuated with vaccines. Despite these scientific wonders that protect public health, the struggle continues in many areas to achieve maximum protection by reaching needed vaccination rates. As of March 28, 2019, 387 cases of measles had been reported.1Centers for Disease Control and PreventionMeasles Cases in 2019.https://www.cdc.gov/measles/cases-outbreaks.htmlGoogle Scholar Two states were having the largest outbreaks, New York and Washington. In Rockford, New York, 161 cases (as of April 3) had been reported so far and lack of cooperation from infected individuals prompted the fairly drastic response of banning unvaccinated individuals under age 18 from public spaces.2LaMotte S. Why New York hasn’t contained the largest and longest measles outbreak in decades. CNN. March 29, 2019.https://www.cnn.com/2019/03/29/health/measles-ny-outbreak-fear-misinformation/index.htmlGoogle Scholar In response to the large outbreak in Washington, state legislation was introduced for the first time to protect all schoolchildren by disallowing parental use of personal or philosophical exemption. You can read about measles, mumps, and pertussis from Michelle Papachristanthou and earn CE credit in this issue. Unfortunately, just across the southern border in Oregon and in other states (New York and Texas, with outbreaks this year), legislators were proffering expanding exemptions. Similarly, in West Virginia, where only medical exemptions are allowed to avoid vaccination, a bill has been introduced to include philosophical or personal beliefs as reasons for not complying with vaccine policy. So far this year, legislation related to vaccines has been introduced in 30 states.3National Vaccine Information CenterMore than 100 Bills Proposed in 30 States to Expand, Restrict or Eliminate Vaccine Informed Consent Rights, February 17, 2019.https://www.nvic.org/nvic-vaccine-news/february-2019/more-than-100-vaccine-bills-proposed-in-30-states.aspxGoogle Scholar There are, of course, larger political agendas behind many of these bills, but beyond the politics, the fact remains that the diseases we once thought banished are resurging. Polio, once thought to be virtually eradicated, has demonstrated its resilience. The Centers for Disease Control and Prevention (CDC) reports 27 cases of wild polio virus worldwide, already surpassing the 22 cases reported in 2018.4Centers for Disease Control and PreventionMMWR Polio Reports. March, 8, 2019.https://www.cdc.gov/mmwr/polio_reports.htmlGoogle Scholar Vaccine-derived polio occurs when the weakened vaccine virus is excreted and spread in the community. Outbreaks have occurred in Africa (Somalia, Kenya, Republic of Congo, Niger) and Papua New Guinea. Given the commonplace international travel to these areas and the pockets of undervaccination there, it is not hard to see how containing these and other viruses will continue to be a risk for the rest of the world. What can nurse practitioners do when a patient/parent refuses or is hesitant about vaccination? Should you dismiss the patient from your practice? This issue sparks significant debate on many grounds—legal, ethical, and health. While I may sometimes feel like it, I know that dismissing a patient or family would mean I would never have the opportunity to positively influence them again, so I grit my teeth, smile, and try to follow the expert guidance of the American Academy of Pediatrics (AAP).5Edwards K.M. Hackell J.M. Committee on Infectious Diseases, the Committee on Practice and Ambulatory Medicine. Countering Vaccine Hesitancy.Pediatrics. 2016; 138https://doi.org/10.1542/peds.2016-2146Crossref Scopus (196) Google Scholar Strategies for communicating with families about vaccine hesitancy include to acknowledge parents’ concerns but continue to provide the message that vaccines are safe and effective; without vaccines children are at risk for serious illness, disability, and even death; and the current recommended schedule is how they should be administered. Focus on the joint goal of what is best for the child. Stories about unvaccinated persons can be powerful. The Immunization Action Coalition (www.immunize.org ) has documented examples and many other tools to help you improve vaccination processes and rates. Personal stories about vaccinating your own children or family members can also be persuasive. Combating vaccine misinformation when you spot it on social media is another way to make a difference. Respond with facts backed up by evidence from respected resources like the World Health Organization, the CDC and the AAP. On a global basis, the organization [email protected] has a social media kit available with their Advocate2Vaccinate campaign (https://shotatlife.org). Despite the challenges to overcoming vaccine hesitancy and improving access to vaccines for all, our vigilance is a must to improve quality of life and health for our patients and those they interact with around the world. Keep improving practice,