A Public Concern

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Joshua Sharfstein, associate dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health, speaks to the efficacy of vaccines at a special measles symposium held Monday. ( Johns Hopkins Bloomberg School of Public Health)
Joshua Sharfstein, associate dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health, speaks to the efficacy of vaccines at a special measles symposium held Monday. ( Johns Hopkins Bloomberg School of Public Health)

Baltimore’s medical establishment stood shoulder to shoulder on Monday, Feb. 9 to declare unequivocally: Vaccinations work.

Standing in front of her colleagues from Johns Hopkins University, Mercy Hospital, the University of Maryland Medical Center, Sinai Hospital and other regional partners at the special Measles Symposium at the Hopkins’ Bloomberg School of Public Health, newly appointed Baltimore City Health Commissioner Dr. Leana S. Wen did not mince words when it came to state health care workers’ stance on childhood vaccination.

“We stand here as pediatricians and public health leaders of Baltimore City and County to express our solidarity with the importance of childhood vaccinations,” said Wen. “For the last 10 years we have had zero cases of measles in Baltimore. That means zero deaths, zero injuries, zero hurt children, zero tragic families; we have come so far only to see measles take hold again,[and] we cannot be complacent.”

The nation’s recent measles outbreak traces to Disneyland in Southern California but has quickly spread. The Centers for Disease Control released findings Monday indicating that from Jan. 1 to Feb. 6, 121 cases of measles were reported across 17 states and Washington, D.C.

Wen, who began her new role just a month ago, dealt with a suspected case of measles in an infant her first week on the job. Though it turned out that the child had been vaccinated and had not put others at risk, Wen practiced vigilance, cautioning that an outbreak “could happen to anyone, anywhere.”

Maryland, clarified Dr. Laura Herrera Scott, deputy secretary of public health services at the Maryland Department of Health and Mental Hygiene, does not allow exemptions from across-the-board vaccinations for philosophical reasons. It does, however, accept medical and religious exemptions.

“We have seen, practically, patients start their immunization schedule and then patients filing that religious exemption and then stopping those immunizations,” Scott acknowledged, “but that’s only 0.1 percent when we look across all 24 jurisdictions in Maryland.”

She added that Maryland’s immunization rates from kindergarten through grade 12 runs between 97 and 99 percent. Vaccines are not 100 percent effective, and not every person can receive a vaccine; therefore, measles could still crop up, she cautioned. Health officials have floated several ideas to combat a potential outbreak, including exempting children from school when their parents choose not to vaccinate on medical or religious grounds.

Despite the seemingly high rate of immunization in school-age children, more work needs to be done to track the immunization rates of preschool-age children, Scott said.

Citizens should not take the state’s relatively robust public health for granted, said Dr. Joshua Sharfstein, associate dean for public health and training at the Bloomberg School. Sharsftein, who was health secretary under the administration of Gov. Martin O’Malley, was echoed by Dr. Gregory William Branch, director of the Baltimore County Department of Health and Human Services, who said, “Let’s cease the measles. … We can do consultation with our hospitals; we can do consultations to our day-care providers, with our schools 24 hours a day, so if anyone has any questions, they can call the local health department and we can discuss that.

“We have to educate and train the public and our staff as it relates to any type of measles or measles outbreak,” he continued. “We administer the vaccine to our children in our health clinics, also in our school wellness-based clinics. We do surveillance, we do monitoring all the time, and, obviously, we have to evaluate and investigate any potential case of measles.”

With would-be presidential candidates Sen. Rand Paul of Kentucky and Gov. Chris Christie of New Jersey publicly questioning the nation’s vaccination stance, it was fitting that former U.S. Rep. Henry Waxman of California addressed the symposium to give his views on the politics of vaccines.

[pullquote]Let’s cease the measles. … We can do consultation with our hospitals; we can do consultations to our day-care providers, with our schools 24 hours a day.[/pullquote]

“When you have a matter that threatens the public, government has an important role to play. This is not a partisan issue,” said the former congressman, noting that there has been broad bipartisan support for immunizations. In the 1980s, he said, legislators from both sides of the aisle rejected budget cuts put forth by President Ronald Reagan to the federal vaccination program.

It was also through bipartisan support that led to the establishment of the National Vaccine Injury Compensation Program, a no-fault program that compensates families who claim injury from vaccinations. The existence of the fund is pointed to by anti-vaccine groups as proof that vaccines are unsafe; in his remarks, Waxman contended that the fund had to be created to incentivize manufacturers to produce vaccines without fear of being sued. Furthermore, he said, the trust, which is funded by a tax on vaccines, runs at a surplus.

Daniel Salmon, deputy director of the Institute for Vaccine Safety at the Bloomberg School, addressed parental concerns and what can be done to encourage vaccination, such as providing corrected information, taking a presumptive position rather than a participatory position and educating women during pregnancy.

Parents want self-disclosure — “Have you vaccinated your own children?” — said Dr. Debra Roter, a professor at Hopkins. Physicians and parents need to build partnerships and physicians must firmly confront misinformation without coming across as condescending.

Several presenters were hesitant to recommend pediatricians dismissing families that refuse to vaccinate either in part or in full, as that is likely to ruin any future hope of those families reconsidering, and it can push them toward physicians or alternative health care practices that do not follow official recommendations.

As the symposium wound down, two physicians came forward to explain why they signed onto the Baltimore Statement on Childhood Vaccinations, which codifies the stance of the state’s health community.

Dr. Steven J. Czinn, chairman of pediatrics at the University of Maryland School of Medicine, said, “I am a pediatrician, but I am also a parent of four beautiful children. As parents we have an obligation, a responsibility to keep our children out of harm’s way, so I’d like to address my comments to parents who have not vaccinated or have not vaccinated against measles: I ask you to contact your healthcare providers today.”

Dr. Joseph Wiley, chief of pediatrics at Sinai Hospital and a pediatric oncologist, said he fears for his patients who are susceptible to vaccine-preventable illnesses. He concluded with a personal story.

“I haven’t missed a day from work for illness in 31 years, but the sickest I ever was in my life was when I was 5 years old and I had measles,” he said. “I would never want to see anyone go through that. We have the ability to prevent that from happening in the future to our children.”

mapter@midatlanticmedia.com

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