Doctors advised to be on alert for vaccine-preventable diseases

Experts suggest learning the symptoms of measles, mumps, pertussis and other illnesses and developing plans to minimize their transmission.

By Christine S. Moyer — Posted May 16, 2011

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Last year, California experienced its worst pertussis epidemic in more than 50 years. The bacterial illness killed 10 infants and hospitalized more than 700 adults and children, and it has infected more than 1,000 people this year.

Health officials in Minnesota are battling measles, which has infected about two dozen people. The outbreak is considered serious due to how easily the disease can be transmitted.

Mumps began spreading through largely Orthodox Jewish communities in New York and New Jersey in 2009. More than 1,500 cases have been reported.

With the resurgence of these vaccine-preventable diseases in parts of the United States, infectious diseases experts are urging physicians to be alert for these illnesses. They also are encouraging doctors to take measures to prevent the transmission of these diseases among their patients and staff.

"Vaccine-preventable diseases are not gone," said Kathleen Harriman, PhD, MPH, an epidemiologist in the Immunization Branch of the California Dept. of Public Health. "The only disease that really has ever been eliminated is smallpox. The rest might be well-controlled in the U.S., like measles, but they're still around."

Doctors often struggle to identify such diseases, because vaccines are so effective that they rarely see the illnesses, said Andrew Bonwit, MD, an infectious diseases pediatrician at Loyola University Health System in Maywood, Ill. The early stages of some vaccine-preventable diseases also have symptoms that can be mistaken for viral respiratory infections, he said.

A study published online April 28 in The Journal of Infectious Diseases found that health professionals' unfamiliarity with measles led to a delay in diagnosis and contributed to the spread of the disease in Arizona in 2008. During the outbreak, 14 unvaccinated people were infected. Half of the infections were acquired in health care settings. It is the largest reported health care-associated measles outbreak in the U.S. since 1989, the study said.

To ensure timely diagnosis of these diseases, Dr. Bonwit encourages doctors to familiarize themselves with symptoms. He said they regularly should check the Centers for Disease Control and Prevention's website for information on outbreaks and trends across the country.

Doctors "need that index of suspicion, because [vaccine-preventable diseases] might be what makes a patient symptomatic," Dr. Bonwit said. "We need to keep reminding ourselves that no matter what high-tech tests you used, you need to take a complete [patient] history."

Making the diagnosis

A patient history should include questions about whether an individual traveled recently and if he or she is up to date on all CDC-recommended vaccines, said Robert Hopkins, MD, a Little Rock, Ark., internist and pediatrician.

Many cases of vaccine-preventable disease reported in the U.S. often are acquired in other countries, the CDC said. For this reason, experts urge physicians to be aware of infectious disease outbreaks globally.

Another key to accurate diagnosis is paying close attention to the complaints of the patient or the individual's parents, Harriman said. This is particularly important to identify pertussis in infants who do not usually have the characteristic whooping cough, she said. Instead, the child might have cold-like symptoms but appear otherwise healthy. Parents of infants with pertussis often say the child seems to be gagging or gasping for breath and vomiting.

Physicians also need to be vigilant to prevent the spread of these illnesses to other patients and staff, experts say. The measles virus can linger in the air for up to two hours after an infected person coughs or sneezes, the CDC said. This means patients and staff can contract the disease by being in a common area or an exam room formerly occupied by someone with the illness.

At Children's Hospitals and Clinics of Minnesota in the Twin Cities area, wall posters alert patients to the symptoms of measles and urge them to notify staff immediately if they have them, said Gigi Chawla, MD, a pediatrician and past chief of staff of the medical center.

When measles is suspected, health professionals should give the patient a face mask to wear and immediately move the individual to an exam room, Dr. Chawla said. She said face masks also should be distributed to patients in common areas who are coughing.

Infectious diseases experts encourage physicians to establish separate waiting areas for sick patients and those who are there for a well visit.

Vaccination is key

The most important step physicians can take is making sure patients and staff are immunized against these diseases, said Dalilah Restrepo, MD, infectious diseases specialist at St. Luke's-Roosevelt Hospital Center in New York City.

"A lot of these diseases are spreadable before you even have manifestations" of the illness, she said. "The only way to prevent [transmission] is vaccination."

Legislators in Texas are considering a bill to require hospitals and inpatient medical facilities to immunize people who provide direct patient care against vaccine-preventable diseases. Senate Bill 1177 passed the Senate in April and was in the House public health committee at this article's deadline.

Carol J. Baker, MD, chair of the CDC's Advisory Committee on Immunization Practices, said physicians should not give up on parents who choose not to vaccinate their children.

She said to tell parents, "Vaccines are good. Vaccines are safe. Vaccines prevent very bad diseases."

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External links

"Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact," The Journal of Infectious Diseases, published online April 28 (link)

Centers for Disease Control and Prevention on measles (rubeola) (link)

California Dept. of Public Health on pertussis (link)

Minnesota Dept. of Health on measles (rubeola) (link)

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