This Halloween, Vaccine-Preventable Diseases Are All Trick and No Treat: Public Health Watch

Forget the candy this Halloween. Get your kids vaccinated.

That’s the underlying message of some recent news regarding communicable—and vaccine-preventable—diseases, just in time for trick or treating. For starters, there’s an ongoing rubella outbreak in Japan to worry about, and some concerning new data on influenza from the US Centers for Disease Control and Prevention (CDC).

First, rubella: Reports suggest that more than 1100 cases of the disease have been confirmed in Japan, mostly in Tokyo, Kanagawa, Chiba, and Saitama prefecture. The CDC has issued a warning to Americans who plan to travel to the Asian nation, touting the MMR vaccine. The agency has also used the outbreak to remind women that rubella infection occurring during early pregnancy has been linked with miscarriages, stillbirths, and severe birth defects, including congenital rubella syndrome, in infants.

There’s a need to do so, obviously, given the ongoing concerns regarding MMR vaccine uptake in the United States and elsewhere. As Contagion® reported last year, vaccine uptake has generally been on the upswing in many states as a result of legislation designed to limit “personal belief” exemptions among eligible children. However, the issue remains a significant cause for concern in Europe where, as Contagion® chronicled in August, there have been thousands of cases and ongoing outbreaks in numerous countries, thanks in large part to poor vaccine uptake.

“The most effective way to prevent rubella infection is through vaccination; therefore, it’s likely that there’s a susceptible, unvaccinated population and insufficient herd immunity [in Japan] to provide protection,” Kristi L. Koenig, MD, FACEP, FIFEM, FAEMS, Medical Director, EMS, County of San Diego, Health and Human Services Agency, and Professor Emerita, Emergency Medicine and Public Health, University of California, Irvine, told Contagion®.

Dr. Koenig, who spoke at a conference in Taiwan over the weekend that delved into related subjects said that experts on public health in Japan told her that MMR vaccine coverage there has been inconsistent. Japanese citizens born after 1990, they noted, are eligible to receive vaccines twice, at the government’s expense; however, women born between 1961 and 1986 and men born between 1979 and 1986 were provided with government-funded vaccination only once, and the Japanese government didn’t provide vaccines at all to men born prior to 1979.

In response to the situation in Japan, Dr. Koenig advised clinicians to “consider measuring serum titers to confirm immunity… for those patients previously vaccinated [and] counsel patients that, while the last major US epidemic was in 1964-1965, and rubella has been eradicated in the United States since 2004, it remains common in other countries, so it’s important to be vaccinated prior to travel.

“Patients should be counseled about other diseases as well,” she continued. “For example, influenza vaccination is also essential prior to travel and [influenza is] far more likely to be encountered than rubella. Unlike the rubella vaccine, pregnant patients can receive influenza vaccine, via injection.”

Interestingly, the CDC remains much less sanguine about the battle against influenza domestically. An analysis released by the agency on October 25 revealed that influenza vaccine uptake among adults during the 2017-2018 season was just 37.1%, a drop of 6.2% from the previous year. The agency believes the drop likely contributed to the more than 49 million reported influenza cases in the United States during winter 2017-2018, more than 960,000 of which resulted in hospitalization. More than 79,000 deaths last winter were attributed to the flu.

Of course, according to the CDC, last season’s flu strain—H3N2—rendered the commonly available vaccine less effective.

Finally, setting an ominous tone for the coming season, the New York City Department of Health (NYCDOH) announced on October 24 that a child in the city died of influenza, marking the first flu-related fatality for 2018-2019 in the Big Apple. According to media reports, the NYCDOH did not release the child’s age or vaccination status, citing privacy concerns, although it did note that roughly two-thirds of children in the city receive the vaccine annually.

And just to bring things full circle, in nearby Rockland County, NY, public health officials have confirmed 15 cases of measles and ordered non-vaccinated children to stay home from school through November 3—21 days from last known exposure.

So while ghosts, ghouls, goblins may be top of mind today, parents need to be reminded that they can protect kids and themselves from some really scary things—both at home and abroad—with a simple shot in the arm. Consider that information a Halloween treat.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.