Measles, Mumps, Rubella... Forgotten but NOT Gone

There is no decision more personal than whether or not to immunize one's children. Information regarding the safety and effectiveness of today's vaccines is readily available but is overshadowed by opinion and hyperbole offered up by celebrities and others. In light of significant recent outbreaks of vaccine-preventable diseases all over North America, it's a good idea to explore the issues. Nurses Announcements Archive Article

Measles, Mumps, Rubella... Forgotten but NOT Gone

To immunize or not to immunize... that is the question. When I was growing up, there really wasn't any controversy - when we were in certain grades, we were all lined up at school and the public health nurse either gave us a shot in the arm or a little pink drop of sugary liquid on a plastic spoon. I have a nice, circular scar on each of my upper arms just below my shoulders that signify my immunization against smallpox, the only disease to have been declared eradicated from the Earth. When my children were small they each were given their shots according to the vaccination schedule of the time. It's what we did. Then came Andrew Wakefield.

The study published by Mr Wakefield purported to link immunizations with the development of autism and it set the world on its ear. The fact that this study has been debunked scientifically a number of times seems not to penetrate the consciousness of a growing group of parents who feel that herd immunity will protect their children. The principle of herd immunity is simple: if enough of a herd of any species is immune to a microbe the odds of an outbreak of that microbial disease are extremely low. And should an outbreak occur, it rapidly diminishes as the number of susceptible hosts drops. Well, guess what... the herd isn't immune any more.

Outbreaks of vaccine-preventable diseases like measles, mumps, rubella, pertussis and varicella have been documented all over complacent North America. Combined with a falling immunization rate, high-speed intercontinental travel allows these diseases to gain a toehold and then they are free to run rampant through populations with low or NO herd immunity. Communicability begins before the infected host becomes symptomatic, so spread is difficult to contain once it begins. Measles had been declared eliminated in the Americas in 2002, with small sporadic outbreaks annually; there were 85 cases on the continent in 2005 and as many as 253 in 2010. But in 2011, the WHO American region reported the highest number of cases seen since the disease was reported eliminated. My city has just recorded its second measles case in as many weeks after years of zero cases and we've had two infants with congenital rubella admitted to our PICU in recent months.

"So what's the big deal?" people say. Health care has changed since the 50s and 60s, and kids don't die of vaccine-preventable diseases any more. Right? Wrong. Children and adults DO die of these diseases, although the number is small and complication rates remain manageable. For now, at least. Even so, people still believe that it's all hype and not really anything to worry about. They forget about the children and adults who are unable to be immunized, not for lack of wanting it but because of other health issues. Children with cancer, blood dyscrasias, organ transplants and certain neurological disorders cannot be immunized against certain diseases. Adults who have been inadequately immunized as children for whatever reason are also at risk. And it's this population who are at risk for dying from chicken pox. Or measles. Or to become sterile from the mumps. Or to have a baby with severe anomalies from congenital rubella. It's not a joke.

In the course of researching my family tree I have come across entire families wiped out by pertussis and measles, and others by typhus, cholera, or scarlet fever (infections that while not vaccine preventable, have been essentially eradicated by modern-day antibiotics and sanitation practices). I'm always deeply saddened when I find them, and I fear that if the current complacency and disdain for immunization continue we may find ourselves right back there.

As pediatric nurses we have a unique opportunity to help make this better. We have many teachable moments in the course of our workday where we could reinforce the message that not only are vaccinations safe and effective, but also that parents aren't only protecting their own children, they're protecting those they encounter out in the world who aren't lucky enough to be able to protect themselves. We can remind them that no one knows what the future might bring and that someday they may find themselves with a child who can't be immunized. I remember a family that had 5 children. None of them were immunized because the mom was opposed. Their fourth child became critically ill and needed a heart transplant. The discussions with this mother were intense and, on some level vaguely threatening when it was pointed out that the child would surely die if one of the siblings brought home a vaccine-preventable disease after going through a transplant. She asked for some time to research things and in the end agreed to have all of her children immunized.

My challenge to you is to examine your own thoughts and feelings about vaccinations from a scientific rather than an emotional perspective. Then I challenge you to formulate your responses to parents who are on the fence about having their children immunized so you have them ready when the opportunity arises. Our future is counting on you.

Pediatric Critical Care Columnist

Certified Pediatric Critical Care Nurse and parent of multi-handicapped adult son, married to computer geek.

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loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.

I would love to foreword your post to my oldest sister. However I know I would just be starting a war. She is a staunch advocate of the "vaccines cause autism" camp. Yes she can claim to know people who had perfectly normal children and when they got vaccinated - POOF they became autistic the very next day. I think we could reason with these people until we are blue in the face and they will not listen. Fortunately she is not a nurse.

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

One argument you could try is to point out that even though so many people have refused to vaccinate their kids the number of autism diagnoses continue to rise. Now does THAT make sense?? You might also point out that in the olden days when I was a kid and everybody was vaccinated, there were very few cases of autism. Can she explain that?

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.

Oh she would find an article on the internet that would back her up. I pointed out to her that there were some childhood illnesses that were coming back due to people not vaccinating hteir kids. Her response was that these diseases come in cycles and they were due to come back anyways. Sigh.

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.

Have you ever watched this:

branb5435

9 Posts

I am a pre nursing student and also a parent who does not vax. I am not debating the topic because I know that people like myself are looked down upon here, but I need to clear up one misconception. The majority of people I have met that do not vax do not base their decision on the autism link. They don't listen to celebrities. They are parents who spend hours upon hours researching and agonizing over decisions for their children. We are constantly researching and are open to the idea of vax if we feel it is in the best interest of our children. Right now, we don't.

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.
I am a pre nursing student and also a parent who does not vax. I am not debating the topic because I know that people like myself are looked down upon here, but I need to clear up one misconception. The majority of people I have met that do not vax do not base their decision on the autism link. They don't listen to celebrities. They are parents who spend hours upon hours researching and agonizing over decisions for their children. We are constantly researching and are open to the idea of vax if we feel it is in the best interest of our children. Right now, we don't.

The first part of my challenge was to examine your thoughts and feelings without the emotional responses that can sometimes cloud the issue. As a pre-nursing student you have yet to see a child born without a functioning immune system die from complications of chicken pox. You've yet to witness the continual episodes of coughing that lead to apnea and bradycardia in infants too young to be immunized who catch pertussis from an adult who didn't know they had it. Some of those children are brain-injured and others die. You may never hold a new mother while she cries after being told her baby's heart is so malformed from maternal rubella that it can't be fixed and he will die. You may never see a child on long-term cardiopulmonary bypass (ECMO) because he didn't get a flu shot. I've done all these things, some of them more than once. It changes you.

I sincerely hope that you inform the parents of children yours interact with that they aren't immunized so they may make the choice to protect their own. I wonder if you realize that entry to nursing school and employment in health care require that you be immunized against a variety of bugs as a condition of admission/employment. Some facilities have mandatory flu shot programs. And in the case of a measles or chicken pox outbreak in your area, you may be required to remain home without pay for the duration unless you can prove your immunity. You might also consider immunization against hepatitis B, a blood-and-body-fluid-borne pathogen nurses are exposed to a lot without knowing it. Make your choices wisely.

allnurses Guide

BostonFNP, APRN

2 Articles; 5,581 Posts

Specializes in Adult Internal Medicine.
I am a pre nursing student and also a parent who does not vax. I am not debating the topic because I know that people like myself are looked down upon here, but I need to clear up one misconception. The majority of people I have met that do not vax do not base their decision on the autism link. They don't listen to celebrities. They are parents who spend hours upon hours researching and agonizing over decisions for their children. We are constantly researching and are open to the idea of vax if we feel it is in the best interest of our children. Right now, we don't.

Based on what data?

Edit for clarification: I don't mean to be a jerk and ask, but as a nursing student that has exhaustively researched the topic I am curious which study in particular you find most compelling.

In my experience, parents that don't vaccinate, for the most part, have no idea how to critically evaluate the extant literature and develop an opinion. Most consider googling "why shouldn't I vaccinate my kids" appropriate research.

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.
I am a pre nursing student and also a parent who does not vax. I am not debating the topic because I know that people like myself are looked down upon here, but I need to clear up one misconception. The majority of people I have met that do not vax do not base their decision on the autism link. They don't listen to celebrities. They are parents who spend hours upon hours researching and agonizing over decisions for their children. We are constantly researching and are open to the idea of vax if we feel it is in the best interest of our children. Right now, we don't.

I hope that you don't allow your personal beliefs get in the way of educating your patients about vaccines.

NurseSN45696

170 Posts

I am a pre nursing student and also a parent who does not vax. I am not debating the topic because I know that people like myself are looked down upon here, but I need to clear up one misconception. The majority of people I have met that do not vax do not base their decision on the autism link. They don't listen to celebrities. They are parents who spend hours upon hours researching and agonizing over decisions for their children. We are constantly researching and are open to the idea of vax if we feel it is in the best interest of our children. Right now, we don't.

What will do you do when you get in to nursing school and are required to get the MMR vaccine & titers do not prove immunity? :specs:

Just got mine done this morning.

JDZ344

837 Posts

Those who refuse to vax are playing Russian roulette with their kids lives.

kp1987

400 Posts

I would think having a child with autism is better than having your child dying. Vaccinate!