Dr. Policastro
We know that second hand smoke puts others at risk. Driving under the influence of alcohol puts others at serious risk. There are other behaviors like that which can affect the health of those around us.
One example of this can be found in the South Carolina measles epidemic. Some individuals have chosen to not have their children get the measles vaccine. As long as they are choosing to only have their own children get naturally occurring measles, that is the choice they have made.
We already know that the way to prevent a measles epidemic is by having over 95 percent of the population vaccinated. Therefore, if more than five percent of the population makes this decision, they are subjecting the community to a measles outbreak.
An additional problem occurs if they decide to take their child with measles to the doctor. They will sit in a waiting area with a child who is infectious.
Also in that office are well babies and sick infants under the age of one year. We do not give the measles vaccine under 12 months of age, except in certain circumstances. The reasons are immunologic in nature.
The mother’s antibodies to measles are carried across the placenta before birth to the infant. It offers partial protection for a few months. However, we know that if you cannot give the vaccine before those antibodies disappear.
If you do that, then any response to a vaccine will be blunted. The infant will not have the full effect of the vaccine. Therefore, the first dose needs to wait until at least 12 months of age.
If the infant is exposed to measles before that happens, those antibodies, even though present from the mother, are low enough to not protect the infant. Therefore, the infant will likely get the infection.
Measles infection in children under one year of age is dangerous. The mortality rate is somewhere between one in 10 and one in 20 infants. Fortunately, in a society where measles is rare (like it has been for the last 26 years in the United States), this is not often an issue.
However, in a situation like the one that occurred last year in Texas and is now occurring in South Carolina, the story is different.
Doctors in offices and Emergency Departments often have to leave the office to go out to the parking lot to make sure a child does not have measles before letting them indoors.
Many younger physicians have not seen measles very often. However, in my early years as a pediatrician, I saw it quite frequently. I often talked about them having a “measly” appearance. I could literally walk in the door of a room, look at a child, and make the diagnosis of measles without an exam.
Therefore, screening in a parking lot is not that farfetched. But it is interesting that over 50 years since we have had a vaccine, we are now going back to the old days of medical practice.
We need to realize that we live in a society where sometimes our decisions can impact others. If the doctor asks us to wait in a parking lot, that might make perfect sense. We should welcome that and not get upset. We do not want the infants in the office unnecessarily exposed to a serious illness.