By Erin Hayden
In 2014-15, a record 885 cases of measles were reported, including outbreaks at Disneyland, exposure precipitated by international travel and cases concentrated within isolated pockets of unvaccinated communities.1-2 Although the number of measles cases has since reduced, risk is still present. In February 2018, Allegheny County saw a confirmed case of the measles in a fully vaccinated person. At current time, no other cases have been confirmed, but the 7 to 21-day incubation period for the virus delays detection of signs and symptoms. Mumps have also resulted in several outbreaks recently, including one in 2014 that hit the National Hockey League (NHL) and another outbreak in Arkansas in 2016-17 that affected over 3000 individuals.3 Outbreaks of these diseases result from a combination of factors, including lack of vaccination among groups, but also the longevity of the antibodies and immune response formed in individuals that are vaccinated.
MMR stands for measles, mumps and rubella, and commonly refers to the vaccine product used to prevent these diseases. These are three separate viral illnesses that are serious and spread easily through personal contact and airborne transmission. Measles is an airborne disease characterized by high fever and rash, while rubella is a form of measles with similar symptoms as well as the potential to cause birth defects/miscarriage in pregnant women. Mumps presents with painful/swollen glands and lymph nodes, as well as widespread body pain, fatigue and fever. Complications of mumps can include deafness and meningitis. In the United States, these diseases could be completely eradicated due to the availability of the highly effective MMR vaccine.
In 1998, falsified research was published by Andrew Wakefield suggesting a link between autism and the MMR vaccine. Despite retraction of the paper and loss of Wakefield’s medical license, detrimental effects continue to linger today, leading to a resurgence of disease across not only the United States, but across the world. The sweeping ‘anti-vaxxer’ movement has many parents opting out of vaccinating their children for fear of adverse effects or criticism of vaccine product components. In many states, parents can sign an exemption form to avoid vaccination for their school-aged children due to medical, religious or philosophical reasons. According to the Centers for Disease Control and Prevention (CDC), only 91.9% of children aged 19-35 months have received the MMR vaccine in 2016.4 While this seems high, typically when vaccination coverage falls below 90-95%, the risk of outbreaks increases due to a loss of herd immunity.5 Vaccines not only provide personal protection against disease, but also indirect protection when large proportions of the population have immunity. Additionally, some individuals are medically unable to receive vaccinations due their age or medical status and rely solely on herd immunity.
The normal MMR vaccination schedule consists of a two-dose series at 12 to 15 months and then again at 4 to 6 years old.6 The CDC recently voted in October 2017 to recommend a third ‘booster’ shot for the MMR vaccine specifically for at-risk patients during outbreaks. This recommendation has been prompted due to increases in mumps outbreaks in the US since 2015. With two vaccinations, the MMR vaccine is approximately 97% effective against measles and 88% effective against mumps.7 However, effectiveness can decrease over time, and certain individuals can be particularly vulnerable, including students at universities, healthcare personnel and international travelers. A third dose of MMR has been found to be effective in reducing the risk of mumps during outbreaks, according to a report in the New England Journal of Medicine.8
The best way to prevent against outbreaks is to ensure that everyone who is able receives full vaccination against preventable illness. As we learn more about vaccine longevity and immune response, strategies such as an MMR booster provide useful extra protection during times of need, such as outbreaks. For more information on MMR vaccine and the need for booster vaccination, talk to your doctor or pharmacist, and visit the CDC’s website on MMR: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html
- Scutti S. CDC recommends booster shot for mumps outbreaks. 25 Oct 2017. Available at: www.cnn.com/2017/10/25/health/cdc-mumps-outbreak-syracuse-university/index.html.
- Zipprich J, et al. Measles outbreak – California, December 2014–February 2015. MMWR Morb Mortal Wkly Rep. 2015;64:153-4.
- Centers for Disease Control and Prevention. Mumps cases and outbreaks. 9 Feb 2018. Available at: https://www.cdc.gov/mumps/outbreaks.html.
- Centers for Disease Control and Prevention. National Center for Health Statistics: Immunization. 3 May 2017. Available at: https://www.cdc.gov/nchs/fastats/immunize.htm.
- Hotez PJ. How the anti-vaxxers are winning. 8 Feb 2017. Available at: https://www.nytimes.com/2017/02/08/opinion/how-the-anti-vaxxers-are-winning.html.
- Centers for Disease Control and Prevention. Immunization schedules: Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. 6 Feb 2018. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.
- Centers for Disease Control and Prevention. Measles (rubeola): Measles cases and outbreaks. 9 Feb 2018. Available at: https://www.cdc.gov/measles/cases-outbreaks.html.
- Cardemil CV. Effectiveness of a third dose of MMR vaccine for mumps outbreak control. N Eng J Med. 2017;377:947-56.
This article was written by fifth-year pharmacy student at Duquesne University School of Pharmacy, Erin Hayden, and reviewed by her faculty advisor, Dr. Jordan Covvey.
Erin Hayden is a fifth-year pharmacy student at Duquesne University School of Pharmacy. She has worked in hospital pharmacy for the past four years. In addition to learning more of the clinical side of pharmacy, Erin has taken interest in health outcomes and has initiated research on HIV/AIDs prevention. Looking forward, Erin hopes to work in a clinical setting while being involved in administrative health outcome decisions.
Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in the utilization of healthcare data, such as electronic medical records, for quality improvement in prescribing.