CENTREVILLE — Officially declared eradicated in 2000, the measles disease has made a resurgence. Nationwide, at least 673 cases of the vaccine-preventable illness has been reported in 22 states this year, among them Maryland, according to a preliminary tally of state and local health department data. Those reported cases have now exceeded the highest number on record in a single year since 2000.
While the Centers for Disease Control has determined the recent source of the disease has been linked to travelers who brought measles back from countries such as Israel, the Ukraine and the Philippines, officials say the majority of people in the U.S. who have fallen ill were unvaccinated.
Dr. Joseph Ciotola, Queen Anne’s County Health Officer, medical director for the Department of Emergency Services and recently appointed board member to the University of Maryland Medical System, said that measles was eradicated due to the rise of public health education and vaccines.
The anti-vax movement and a lot of misconceptions about autism and vaccinations contributed to the recent outbreak of measles, Ciotola said, and it is unfortunate there is so much misinformation about the efficacy of the vaccines and prevention of disease.
The British physician who said preservatives in vaccines were contributing to autism and autism spectrum disorders misinformed a large population. His research was found not only to be invalid, but discredited altogether and his medical license revoked, Ciotola said.
Later investigations would find that the physician leading the fraudulent claims was working with a group seeking to sue vaccine manufacturers.
As the health department in Queen Anne’s County, we are very engaged in what needs to be done, and focus on the efforts of public health in protecting the community, Ciotola said.
What vaccines should be administered?
“Maryland has a 98% vaccination rate, and especially on the Shore that rate is high, with no pockets of unvaccinated children,” said Maggie Schmidt, nurse supervisor, communicable disease.
The CDC and American Academy of Pediatrics recommends children birth through 5 years old receive the following series: Hepatitis B, Rotavirus (RV), Tetanus/Pertussis/Whooping Cough/Diphtheria (DTaP), Influenza Type B (Hib), Pneumococcal (PCV13), Polio (IPV), Measles/Mumps/Rubella (MMR), Varicella (chicken pox), and Hepatitis A; along with a yearly flu vaccine. Vaccines to ward against Meningococcal disease (meningitis) and HPV (human papilloma virus) are also recommended at age 11-12.
The county health department offers free vaccines for children through age 18 who are underinsured or uninsured. Three back to school clinics will be held on Aug. 27, Sept. 3, and Sept. 17 from 8 a.m. to 7 p.m. at the health department in Centreville, Schmidt said. Parents or guardians do not need to provide proof of insurance or proof of residency for their child to receive the vaccines.
How do diseases spread?
In most cases, illnesses like the ones vaccinated for – including measles – are spread through the air and the respiratory system when an infected person coughs or sneezes. In Baltimore County, the measles outbreak was travel related and spread only to family members. The event or “outbreak” was reported “over” by June, Schmidt said.
It is important to have the full series of recommend vaccines to make sure you are fully protected, she added.
In Queen Anne’s, we have done a good job to ensure processes are in place to address surveillance against potential symptoms, Ciotola said, adding that when the MD outbreak was reported, the department refreshed the schools on what process to follow if there were to be an outbreak and what symptoms to look for.
Mobile Integrated Health Care Program
Also on Ciotola’s list of of programs to keep the county healthy is the Mobile Integrated Health Care Program (MIHC). Started as a pilot for the state , it has been extremely beneficial for the community, especially the vulnerable population, Ciotola said.
MIHC is now being integrated in several counties across the state and Ciotola anticipates Talbot and Howard counties to be operational in the immediate future, with Caroline County eventually coming on board as well. “It has been very successful and well received,” he said.
Patients are enrolled through referrals from the hospital, linking them to a primary care provider, with one primary goal being medication reconciliation, Ciotola said. Often the primary care physician isn’t aware of the changes made to the patient’s medications while in the hospital or the patient is lacking a primary care physician to begin with; these patients may not go home understanding what medicines they are supposed to be taking.
Tele-medicine and the MIHCP is helping resolve that issue in multiple ways via directly communicating with primary and wrap around care resources, such as associated organizations – hospice, social services, meals on wheels, or mental health, among others. MIHCP allows those individuals to be seen in their home and helps them get access to these other agencies, often making that referral at the time of the initial visit, Ciotola said. With enrollment in the program, individuals are followed for a full year.
With the Chesapeake Regional Information System for our Patients (CRISP) system, statewide tracking is provided for both inpatient and outpatient activities. Via CRISP we know if a patient is seeking medical attention and can follow up if we need to and see what they really need at that point, added Ciotola.
Of the individuals using the MIHCP, 75% in the program are over the age of 65, Ciatoloa siad, and they are a component of broad spectrum of what population is in Queen Anne’s County both from socio economic and educational background. Health literacy is also an issue.
“We are trying to be the advocate with this group of individuals,” said Ciotola.
He also noted the rise of 55 and older communities in the county are only going to increase the medical needs and access for this area, and transportation is an issue.
In conclusion, there is a stronger case for preventative health than leaving it to chance. A concept that plays into not only vaccinating children, but continuity of care for an aging population, experts agree.
There are children who cannot be vaccinated due to their immunocompromised status, Schmidt said, noting that is where herd immunity becomes applicable.
“It is really important for parents to understand that it is their choice to decide whether or not their child is vaccinated, but it is not their choice to decide whether or not someone else’s child becomes ill based on their decision,” she said.
Vaccines are absolutely essential, Ciotola said.