Increases in Vaccine-Preventable Diseases

Any discussion about the spread of communicable disease has to include information on the importance of vaccines. Vaccines are one of the most important public health accomplishments of the 20th century. They have had a dramatic impact on reducing the number and severity of communicable disease outbreaks and are a cornerstone of public health and disease-prevention efforts. Several diseases, such as smallpox and polio, have been eradicated in the United States as a result of vaccination efforts. However, many other vaccine-preventable diseases persist, and in cases such as measles, have increased in prevalence because of lowered immunity in the general population.

Vaccines are listed as the top public health achievement of the 20th century. Over the past century, vaccines have been developed to prevent many diseases. Despite this success, however, more than 3 million individuals worldwide die from vaccine-preventable diseases each year. Approximately 1.5 million of these deaths are in children less than 5 years old.

Starting in 1979 with the Surgeon General's Report, Healthy People, followed by Healthy People 2000: National Health Promotion and Disease Prevention Objectives, Healthy People 2010: Objectives for Improving Health, and now Healthy People 2020, the US Department of Health and Human Services has established national health objectives to serve as the basis for the development of State and community plans. ¹

A national health objective of Healthy People 2020 is to “Increase immunization rates and reduce preventable infectious diseases.”¹ Herd immunity is achieved when the majority of individuals in a community have developed immunity to a particular disease either from receiving a vaccine or from contracting the disease. It has been estimated that a herd immunity of approximately 90% is needed to protect individuals from a particular disease. In communities with high levels of herd immunity, vulnerable individuals are protected because the majority of persons with whom they come in contact are immune to and incapable of spreading the disease.

In recent years, herd immunity has started to drop for certain diseases. This is the result of waning immunity due to increased numbers of individuals who are not vaccinated against a particular disease or waning immunity from the vaccine itself.

VACCINE FEARS

In 1998, a former British surgeon and medical researcher, Andrew Wakefield, published a research paper in support of the now-discredited claim of a link between the administration of the measles, mumps, and rubella (MMR) vaccine and the appearance of autism.² Despite its retraction and the large number of subsequent articles refuting the research of Wakefield, the seed of doubt against vaccine safety was planted. Following the publishing of Wakefield’s article, families around the world stopped vaccinating against MMR. Whether a result of this damaging article or other anti-vaccine information, vaccine levels for MMR have dropped in the United States and levels of the disease have increased as a result. For many families, the fear of adverse reactions or harm from vaccines outweighs concerns of the child contracting the disease.

WHY VACCINES ARE IMPORTANT

Although no vaccine is 100% effective, vaccines continue to be one of the best methods for protecting individuals and communities against diseases. They can also prevent the morbidity and mortality associated with diseases.

Vaccines are currently available to protect against a number of diseases. Many of these diseases seem to no longer pose a threat; however, waning immunity levels could lead to outbreaks of diseases, as is the case with measles. The need for vaccines doesn’t end with childhood. The need continues throughout an individual’s life. Individuals should review their own vaccine records to ensure that they are current on recommended vaccines and continue to be protected from either contracting or spreading disease.

Currently, the US childhood vaccination schedule for children between birth and 6 years of age recommends immunizations for 14 different diseases. Additionally, there are vaccines that are recommended for teens and adults. Some individuals don’t feel that all of these vaccines are necessary since some of the diseases being vaccinated against are now extremely rare in the United States. Each disease for which vaccinations are recommended, however, can causes serious illness or death in unvaccinated populations and might quickly begin to reappear if vaccination rates drop. Each vaccine on the schedule continues to be recommended because of the risks posed by wild infection. Recent outbreaks are a reminder that these diseases can quickly spread if the level of immunity in a community falls.

COST SAVINGS OF VACCINES

Vaccines have been demonstrated to save billions of dollars in both direct and indirect health care costs. Childhood vaccines have the potential to prevent 42,000 premature deaths and 20 million cases of preventable disease among Americans born in a given year. One study found that for every dollar spent on routine childhood immunizations, $10 was saved.³

WHAT CAN WE DO?

Be knowledgeable: Each of us need to remain knowledgeable about vaccines in order to educate patients and the community about the importance and need for vaccines. There are a number of resources to easily stay current on the latest vaccine recommendations. One excellent resource is www.cdc.gov/vaccines/

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Walk the Talk: Make sure you have received all of the recommended vaccines so that you are not only protecting your health and your family’s health, but that you won’t be spreading infections to others. We have an ethical responsibility to not spread disease and illness to those entrusted to our care.

Be a vaccine advocate: There is a very high level of misinformation about the risks of vaccines. Help individuals in the community make sense of the science. One of the strongest indicators of a patient receiving a vaccine is the recommendation of his or her provider.

CONCLUSION

Vaccines continue to be one of the most effective methods of reducing vaccine-preventable diseases. Recent outbreaks are a reminder that vaccine-preventable diseases continue to be a health threat. Every nurse has an opportunity to reduce outbreaks by ensuring that we, our families, and our patients receive education about the importance of being up-to-date on all recommended vaccines.

Audrey M. Stevenson, PhD, MPH, MSN, FNP-BC, holds master of public health and master of nursing degrees and received her doctorate in public health from the University of Utah. She has worked in public health for the past 28 years and is currently Division Director of Family Health Services of the Salt Lake County Health Department in Salt Lake City, Utah. In October 2010, Dr. Stevenson was awarded the American Nurses Association Immunity Award as a result of her efforts to promote the use of tetanus, diphtheria, and acellular pertussis vaccine at public health clinics, resulting in a new protocol at several Utah hospitals to offer the vaccine to postpartum women prior to discharge.

References

1. Healthy People 2020. Immunization and infectious diseases. Health.gov website. www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases. Updated February 3, 2016. Accessed February 3, 2016.
2. Godlee F, Smith J, Marcovitch H. Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ. 2011:342:c7452. doi: 10.1136/bmj.c7452.
3. Zhou F, Shefer A, Wenger J, et al. Economic evaluation of the routine childhood immunization program in the United States, 2009. Pediatrics. 2014;133(4)577-585. doi: 10.1542/peds.2013-0698.