Return of vaccine-preventable diseases has implications for hospital care

"The increasing incidence of VPDs in the United States and Europe and the persistence of VPDs globally means that all clinicians must be prepared to manage infectious diseases previously believed to be controlled or eliminated in order to deliver the highest quality of care to all patients," write Dr. Grete H. Porteous and colleagues of Virginia Mason Medical Center, Seattle. Their article provides anesthesia, ICU, and other hospital-based clinicians with information and evidence regarding vaccines and VPDs -- highlighting the implications for anesthesia, surgery, and other procedures.

New Cases, Potentially Severe Complications of Vaccine-Preventable Diseases

Several factors have contributed to the resurgence of VPDs, including the anti-vaccine movement, the decreasing effectiveness of certain vaccines, adaptation of disease-causing pathogens, and travel to countries where disease rates are higher. A key concept is herd immunity, which describes how entire populations are protected against infectious diseases when a critical percentage of the population is immune.

Particularly where vaccine refusal rates are high, this critical percentage may not be met -- placing communities at risk of VPD outbreaks. The recent measles outbreak linked to visits to the Disneyland theme parks in Southern California "highlighted vulnerabilities of both vaccinated and unvaccinated individuals when exposed to a highly contagious airborne pathogen and the importance of herd immunity," Dr. Porteous and coauthors write.

Their review presents in-depth information on the clinical appearance and management of nine major VPDs: measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, influenza, meningococcal disease, varicella (chickenpox), and poliomyelitis. These infectious diseases, mostly spread by respiratory transmission (droplets), can cause severe cardiovascular, respiratory, or neurological complications.

When patients with VPDs are hospitalized, steps to prevent further transmission are essential, including isolation and sometimes personal protective equipment. Another critical safeguard is immunizations, which are recommended for all healthcare providers and required at some institutions. "Hospital-based physicians…should be prepared to diagnose and treat patients with VPDs, while protecting themselves, their own families, and other patients from infection," Dr. Porteous and colleagues conclude.

In an accompanying editorial, Dr. Avery Tung of University of Chicago discusses the presented information on VPDs in light of the declining vaccination rates in the United States and elsewhere. He emphasizes that the sole study linking autism to vaccines has been "unequivocally discredited" and exposed as fraudulent. While vaccines have been linked to some rare and nonspecific complications, there are few data to confirm (or disprove) any causal link.

"That these established vaccines, which have reduced once-feared diseases to memories, are now actively avoided makes every case of measles-induced blindness or Varicella pneumonitis more tragic," Dr. Tung writes. He urges anesthesiologists to take advantage of "teachable moments" during preoperative evaluations to provide patients with accurate information about the benefits and safety of vaccines.

Dr. Steven L. Shafer of Stanford University, Editor-in-Chief of Anesthesia & Analgesia, comments: "Vaccines work. Failure to get vaccinated results in preventable deaths.

"All physicians have a responsibility to educate their patients about the role of science in modern medicine," Dr. Shafer adds. "It is critical to counter the pseudoscientific nonsense about vaccines promulgated on the Internet."