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Volume 163, Issue 4
Although requests for measles vaccinations are increasing, pharmacists may be limited by state laws.
Pharmacists nationwide are adding medically sound information and vaccination to the growing fight against measles. Five outbreaks were reported in the first six weeks of 2019 in New York, Washington, Oregon, and Texas. All of the outbreaks began with travelers who brought measles back from countries such as Israel and Ukraine, which have active outbreaks, and nearly all of the infected individuals had not received the standard measles, mumps and rubella (MMR) vaccine. The outbreak has grown so troublesome that one New York county banned all children unvaccinated for MMR from its public spaces on March 26th, 2019.
“We are seeing increased demand for vaccination and pushback on anti-vaccine groups,” said Mitchel C. Rothholz, RPh, MBA, chief strategy officer for APhA. “At a minimum, pharmacies are serving as additional outlets for information to the public about the importance of MMR vaccine. They are a conduit to address some of the misinformation that is circulating. And we are seeing more moves restricting philosophical and religious exemptions from vaccine requirements at the state level.”
The CDC notes that among unvaccinated individuals, nine of every ten who are exposed to measles will develop the disease. Measles virus can survive up to two hours in any airspace where an infected person has coughed or sneezed. It can also survive that long on surfaces. The disease is infectious up to four days before the typical rash appears.
About 10% of children with measles develop ear infections and 5% develop pneumonia. Up to 2 in 1,000 die from measles complications. About 2 in 10,000 develop subacute sclerosing panencephalitis (SSPE), usually years later, and die or suffer permanent impairment.
Just what pharmacists can do is based on what individual states allow. In Oregon, for example, where there is a measles outbreak, pharmacists are providing plenty of information, but relatively few MMR vaccinations.
Interest in Measles Vaccine Spiking
The state practice act limits pharmacists to prescribing and administering vaccines without a prescription issued by another provider to individuals seven years or older, noted Amy Valdez, RPh, immediate past president of the Oregon State Pharmacy Association and the association’s representative to the state Immunization Policy Advisory Team. In neighboring Washington, another state with an outbreak, pharmacists have no age limit on vaccination.
“We usually administer about 50 MMR doses a year,” said Beverly Schaefer, RPh, co-owner of Ketterman’s Sand Point Pharmacy in Seattle. “We have done more than 50 doses in the first six weeks of this year alone.”
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Ketterman’s is not an outlier. The Washington Department of Health reported a 500% increase in MMR vaccinations for Clark County, the area most affected by measles, between January 1 and February 16 compared to the 2014-2018 average.
Interest in receiving MMR vaccination runs the age gamut from parents on behalf of newborns to senior citizens, Schaefer said. Older adults generally don’t need MMR vaccination, which was approved in 1963. Most people born before the late 1950s had measles and the infection confers lifetime immunity.
Measles Vaccine and Kids
The vaccination schedule for children is another issue. The usual immunization schedule calls for a first dose of MMR at one year and a second dose between four and six years, Schaefer noted. MMR vaccine labeling states that the second dose can be given as soon as four weeks after the initial dose.
“We are doing a lot of MMR vaccines for parents who want to move their children out of the normal schedule for that second dose,” she said. “And we are seeing uptake for people who are traveling with their kids and for previously unvaccinated children who need vaccination for school trips.”
Even parents who have refused vaccination are changing their minds as their children move into middle school and high school, Schaefer said. Many schools offer travel programs to South America, Asia, or Europe and require MMR vaccination as a condition to participate.
“They try to save face by saying their children have a more mature immune system and can handle vaccination now,” Schaefer said. “When they bring their kids in, I don’t have anything negative to say about the delay. I emphasize what a good thing they are doing to protect the healthy status of their child, that they are making a positive choice for the future.”