Page 40 - Christiana Care Focus

Pharmacy Services | Therapeutic Notes
Measles, mumps and rubella
The importance of vaccination
Measles, mumps, and rubella are contagious, viral diseases with po- tentially dangerous consequences. Serious complications of measles include ear infections, pneumonia, encephalitis and death. In 2000, 37 years after the advent of the measles vaccine in 1963, measles was declared eliminated from the U.S. However, there were a total of 372 cases of measles reported in 2018. The incidence is significantly increasing, with 704 cases reported so far in 2019.
A decade before the first measles vaccine, an average of three million to four million individuals were infected in the U.S. per year with 400 to 500 deaths among them.
Serious complications of the mumps include inflammation of the testes (orchitis) and ovaries (oophoritis), meningitis and encepha- litis. There were 2,251 cases of mumps reported in the U.S. in 2018, with 736 cases of mumps reported so far in 2019.
Rubella is similar to measles, though it is caused by a different type of virus. Rubella complications include arthritis, encephalitis and severe birth defects known as congenital rubella syndrome (CRS). The last major U.S. rubella epidemic was 1964 to 1965, and approx- imately 12.5 million people were infected; 11,000 pregnancies were lost; 2,100 newborns died; and 20,000 babies were born with CRS. The increasing number of outbreaks reported recently and the po- tential for significant morbidity and mortality indicate a need for an improvement in our vaccination rates.1
The measles-mumps-rubella (MMR) vaccine is recommended by the Centers for Disease Control (CDC) to help protect against these dis- eases. It is a live, attenuated (or weakened) vaccine that stimulates the immune system to create antibodies with very few symptoms. It is still possible for individuals to contract measles, mumps or rubel- la after viral exposure; however, symptoms will generally be milder in vaccinated patients.
The CDC recommends all children receive the first dose of the two-dose series between the ages of 12 months and 15 months. The second dose should be received at 4 years to 6 years of age. If there is any delay in receiving the first dose at the recommended age, then the second dose may be administered four weeks after the first dose. The vaccine is both safe and effective. Two doses of the vaccine pre- vent measles 97% of the time and mumps 88% of the time. One dose of the vaccine prevents rubella about 97% of the time.1
In Delaware, the MMR vaccination rates were approximately 93% in 2017 among children 19 months to 35 months of age.1 However, many other states have significantly lower vaccination rates. One of the reasons for this is the perceived benefit of herd immunity, which is believed to indirectly protect unvaccinated individuals. Some parents knowingly do not wish to have their children vaccinated or delay vaccination because of little obvious risk, since they are ben-
38 CHRISTIANA CARE HEALTH SYSTEM
Tracie Sellers, Pharm.D., and Jina Patel, Pharm.D.
efitting from the fact that most individuals are already vaccinated, making these diseases rarer.
Many may believe there is no need to be vaccinated for diseases that are disappearing or may prefer disease-induced immunity. Other barriers that may prevent an individual from being vaccinated include moral or religious reasons, the large number of vaccinations that are recommended, lack of access and lack of information.2
There have been many misconceptions related to vaccinations, especially related to side effects. Many are concerned that vaccines cause autism.2 Much of this concern stems from the Wakefield, et. al article that was published in the Lancet in 1998, which was later withdrawn in 2010. A great number of studies have provided evi- dence that vaccines have no relation to autism. One study involving vaccines and autism is the Madsen et al study. It was a retrospective cohort study conducted in Denmark. A total of 440,655 children had received the MMR vaccine. Of these children around 300 children were diagnosed with autism and approximately 400 children were diagnosed with autistic-spectrum disorders.
The authors adjusted for possible confounders and found no associ- ation between the MMR vaccine and the development of an autistic disorder.3 The Hviid et al study was also a cohort study conducted in Denmark that included about 650,000 children. Approximately 6,500 children were diagnosed with autism (incidence rate 129.7 per 100,000 person-years). The study was adjusted for potential con- founders such as age, birth year, sex and other childhood vaccines. These authors also concluded that the MMR vaccination does not increase the risk for autism.4
The recent outbreaks of what were previously considered rare child- hood diseases have reemphasized the importance of vaccination. The goal is to again eradicate these diseases and prevent unneces- sary morbidity and mortality.
Christiana Care Health System medical practices offer vaccinations to all patients. Employees also may receive their vaccines at Employ- ee Health free of charge.
Making sure that we, as health care professionals, are immunized is a critical step in preventing disease. Sharing evidence-based knowl- edge and protecting our patients, families, and loved ones are key components in serving our communities with excellence and love. 
References
1. CentersforDiseaseControlandPrevention,CentersforDiseaseControlandPrevention, 03 May. 2019, https://www.cdc.gov/.
2. Ventola CL. Immunization in the United States: Recommendations, Barriers and Measures to Improve Compliance: Part 1: Childhood Vaccinations. P T. 2016;41(7):426–436.
3. MadsenKM,HviidA,VestergaardM,SchendelD,WohlfahrtJ,ThorsenP,OlsenJ,Melbye M. A Population-Based Study of Measles, Mumps and Rubella Vaccination and Autism. N Engl J Med. 2002 Nov 7;347(19):1477-82.
4. HviidA,HansenJV,FrischM,MelbyeM.Measles,Mumps,RubellaVaccinationand Autism: A Nationwide Cohort Study. Ann Intern Med. 2019;170:513–520. doi: 10.7326/M18- 2101