It’s hard to discuss the current measles outbreaks without pointing out what experts see as the primary reason for the recurrence of a disease that had been largely vanquished, at least in this country. “The major issue is this overall public health threat that I think the suspicion against vaccines has created,” stresses Carl Schultz, MD, FACEP, a professor of clinical emergency medicine and the director of Disaster Medical Services in the Department of Emergency Medicine at the University of California at Irvine Medical Center. “People are more afraid of the threat from the vaccine than they are from the disease, which is human nature; it just isn’t rational.”
Part of the problem is that most people have never seen measles, so they don’t remember how many people died from the disease before a protective vaccine was developed and licensed back in the early 1960s, explains Schultz. “To them, the fear of the disease is this abstract threat that they have never seen … but they get all of this publicity about the vaccine, and that is right in their face, so they all see [the vaccine] as really the threat,” he says. “It is unfortunate because it is really untrue. And [it poses a] threat from the disease for a lot of people who really can’t get the vaccine because of allergies or medical conditions. For adults, [measles] can be fatal, and for small children, this can be fatal and it is totally unnecessary.”
Schultz says his biggest fear is that the perpetuation of this unrealistic fear of the vaccine will result in real deaths because people fail to get vaccinated. “This is tough because if people got the vaccine in a rational manner, we wouldn’t see native disease in this country. It would basically disappear,” he says.
Consequently, beyond identifying and appropriately treating patients who present with signs of measles, should emergency providers be playing a bigger role in making sure that patients receive the measles vaccine? While many emergency providers would quickly answer in the affirmative, others worry that taking on added public health responsibilities could hamper their ability to respond to acute care crises.
“This is part of a much broader [discussion] on what is the role of emergency medicine in our society going forward,” says Schultz. “Traditionally, it has been basically to deal with flare-ups of acute disease so that people don’t die between the time they come to the ED and they get follow-up, so we handle true emergencies and sort of put the fires out, allowing people to get stabilized and to get further treatment down the line.”
However, increasingly, emergency providers have been taking on a larger public health role. Many EDs, for example, now routinely provide HIV screening, and most provide tetanus vaccinations if someone comes in with a wound and does not have a complete vaccination history, observes Schultz. “There are things we have done, and it is not unprecedented to ask us to do something like measles vaccinations,” he says.
The downside is that the more non-emergency tasks are added to the list of what emergency providers are expected to do, the longer it takes to move patients through the ED and the more such operations cost, says Schultz.
While there is not yet a clear answer on how much of a public health role emergency providers should provide, Schultz says he would not be opposed to providing measles vaccinations on a temporary basis, given the current acuity of the situation. “The [outbreaks] are occurring right now, so if we were to initiate measles vaccines in the ED, I think that might be useful. It might be a way of messaging to the public the importance of that,” he says.
There aren’t that many un-vaccinated people who would be seen in any specific ED, so providing the MMR vaccine would not pose a huge burden, suggests Schultz. “It is not a commitment. We are not going to do this forever, but I think given that the need is right now, and [thinking about] what we could do to make a difference, this is rational,” he says. “As a temporary measure, I would be supportive of doing MMR vaccinations in the ED.”