Central PA Medicine Fall 2020 - 11

daup h i n c m s .o rg

I
Beware of

Vaccine
Preventable
Diseases
By CYNTHIA DEMUTH, MD, FAAP
PA Chapter Immunization
Representative, American Academy
of Pediatrics

magine you are a busy pediatrician seeing patients in your office.
Your next patient is a 16-month-old girl with fever and rash, most
likely viral, nothing unusual. When you walk into the room, however, you see an ill-appearing child with high fever, morbilliform
(measles-like) rash, red eyes, and rhinorrhea. By the way, she missed
her 12-month vaccines, including MMR (measles, mumps and rubella
vaccine), in the midst of the COVID outbreak. Could this be measles?
You start to feel a sense of panic. Measles is not a benign disease. Rare
complications include encephalitis and death. Who was exposed among
patients in the waiting room, office staff, family and friends, etc.?
Measles is highly contagious by the respiratory route. It is so contagious that people born in the pre-vaccine era before 1957 are considered
immune as virtually everyone was infected. Although I had measles as a
child, I have never seen a case thanks to the great success of the MMR
vaccine. In the recent past measles outbreaks have occurred, typically
in groups of unimmunized people. However, spread was limited due
to most people having been immunized. Two doses of MMR vaccine
are highly protective. One of the unintended consequences of the
coronavirus epidemic has been a decrease in the immunization rate for
children. Even though most pediatric and family practices remained
open and continued to see children two years of age and under when
routine vaccines are given, many parents were fearful of leaving the house
and especially fearful of going to a medical office where they might be
exposed to the virus. Despite reassuring them of extensive precautions in
our office (screening for symptoms, wearing masks, seeing well patients
in the morning and sick in the afternoon) the number of well child visits
during the months of peak COVID activity was very low. CDC reported
a marked decrease nationally in ordering of VFC (Vaccines for Children)
vaccines in 2020 compared to 2019. (The Vaccines for Children program
provides free immunizations for practices to administer to low income
children.) CDC also reported a significant decline in administration of
MMR vaccine in 2020 vs 2019. It is scary that a measles outbreak could
be just around the corner. As pediatric and family practice providers it
is our job to recall these children to receive the immunizations which
are so important in keeping them healthy. Between birth and age two
children are protected against thirteen diseases by routine childhood
vaccines. While any vaccine-preventable disease could make a comeback
when immunization rates decline, measles is the most worrisome as it
is so highly contagious and potentially so severe. Let's do our best to
decrease the chance of seeing a child with measles in this era of safe and
effective immunization.

Central PA Medicine Fall 2020 11

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Central PA Medicine Fall 2020

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