In response to the growing measles epidemic, Dr. Alan Kadish has been a leading proponent on the vital necessity to vaccinate children against measles. In addition to recently releasing a public service announcement, Dr. Kadish sat down with Dr. Amanda Cohn, Deputy Director, Immunization Services Division at Centers for Disease Control and Prevention, to discuss the crisis, the vaccine, and the hoax perpetuated by anti-vaxxers.

Dr. Kadish:  There has certainly has been a great deal of public discussion about the measles vaccine and its potential dangers in the past few months.  What do you see as the risk-benefit ratio of the vaccine, and what techniques are you using—and suggest that others can use—to try to make people understand that the risk-benefit ratio is favorable, and that the vaccine should be used?

Dr. Cohn:  The risk of measles infection can be a mild to moderate illness in many children, but measles can also cause pneumonia, encephalitis, and people can die from measles. So I think the important thing for people to understand is that measles can be very serious, and there’s no way to tell who will develop the more serious complications.  At the same time, we have studied the measles vaccine for years and we have a number of studies that have shown that measles vaccine is incredibly safe and very effective.  Most children do not have any side effects from the shot. The side effects that do occur are usually very mild, such as a fever, rash, soreness or swelling where the shot was given. As a parent, I understand that we all want protect our children and keep them from harm. As a doctor and expert in vaccines, I can also say that the best and safest protection we have against measles is the MMR vaccine.

Dr. Kadish:  There is a public perception among some pockets of people in the United States and worldwide that the vaccine is dangerous.  Are there any techniques that you’ve found that can be useful in overcoming those myths? 

Dr. Cohn:  We know that this misinformation and myths at times drive people’s decisions to not be vaccinated or to refuse or delay certain vaccines for their children. You can’t address these issues all at once. You have to really understand the questions and concerns from individuals in these communities. Once we do, we can develop tools to support the community’s trusted sources of information, such as health care providers, community health departments, and community leaders. Engaging and empowering community leaders by providing them with accurate and credible information to counter those misinformation is the most effective way to change the information percolating within a community about vaccines.

Dr. Kadish:  How concerned should we be about the current outbreak?

Dr. Cohn:  We are very concerned about the magnitude of the current outbreak of measles occurring in New York City and New York State.  It’s the largest outbreaks that we’ve had in the United States since 1994. There are multiple factors contributing to that.  Under-vaccination in some communities is certainly one of the key factors, but also there are increased measles outbreaks globally, and increased importation of cases, which brings me to an important point. People traveling abroad need to make sure they are following CDC’s travel vaccine recommendations to help ensure they do not bring measles back into the United States

Dr. Kadish:  If people have had the vaccine, can they feel comfortable that they are protected, or do some groups of people need to have titer testing to make sure that they still have protection against measles?

Dr. Cohn: Just a little bit of background on the MMR vaccine effectiveness may help with this question. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective. A person born before 1957 is considered immune from measles because if you were born before 1957, you probably had measles at some point. Those individuals do not need to be checked or vaccinated. 

For people born between 1957 and 1989, the recommendation was  for a single dose of measles vaccine. In 1989, CDC began recommending 2 doses of MMR vaccine. Individuals who are living in the outbreak community, who have received only one vaccine should get a second dose of the vaccine for the best protection. If the patient’s immunization records cannot be located, the person should get vaccinated.

Dr. Kadish: So the recommendation is simply for a second dose, rather than for any testing of types?

Dr. Cohn:  Yes, for those living in a community where an outbreak is occurring, and also if they are a healthcare worker, or traveling internationally, the recommendation is two doses. However, if you’re not in an outbreak situation, and have received a single dose, you are not recommended to get a second dose.

Part II of this interview.