An editorial written by University of Michigan SPH Professor, Dr. Matthew Davis, appears in the March 15 issue of The Journal of American Medicine. In it, Dr. Davis addresses the challenges facing the vaccination efforts of state governments and healthcare professionals today.
[Photo: Dr. Matthew Davis]
As Dr. Davis explains, there are some communicable diseases that have come close to eradication upon the advent of vaccines, but in recent years have had a resurgence. Two examples of such diseases are measles and pertussis, whose incidences reached all-time lows in the 1980s but as of 2015 have crept back up. In his article, Dr. Davis identifies two contributors to this phenomenon: parental refusal to vaccinate their children, and the waning immunity of those that have been vaccinated.
The 2014 measles outbreak that began in Disneyland yielded data revealing a strong association between the illness and children whose parents had refused vaccination. This information led to the implementation of stricter policies, making it more difficult for parents to obtain vaccination exemptions for their children. However, analysis of an outbreak of pertussis did not point to any direct correlation between vaccine refusal and disease. Rather, waning immunity due to a less effective vaccine may have been the culprit in this case. The current pertussis vaccine is an acellular antigen, which is less immunogenic than the live, attenuated measles vaccine. This type of vaccine can cause immunity to the disease to eventually lessen and an individual can become susceptible again.
While these two issues facing vaccination are distinct, Dr. Davis points out that they are not unrelated. Waning immunity in some might breed skepticism in others about the efficacy or necessity of vaccines, discouraging them from making the decision to vaccinate their children and creating a cycle that continues to work against vaccination efforts.
“There are at least three main opportunities to increase population-level immunity” Dr. Davis says. “First, states with permissive exemption laws should adopt stricter approaches to exemption […] Second, U.S. vaccination efforts should focus on adjusting the recommended intervals between doses of vaccines in effort to reduce waning immunity, or develop novel vaccines with more durable immunity than current options […] Third, current policy focus on vaccine refusal should broaden to include vaccination decisions among adults. Vaccination coverage rates among adults are substantially lower than among young children.”
These obstacles that are combating vaccination efforts and population immunity are of significant importance to the field of public health. As Dr. Davis puts it, “each case of vaccine-preventable disease — particularly if it results in death or disability — represents a failed opportunity to prevent disease.”
Find the article here: http://jama.jamanetwork.com/article.aspx?articleid=2503155