Vaccines have been a hot topic among parents, pediatrician and in the media for many years.  Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule.   These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of a vaccine-preventable disease in the community.  No pediatrician wants to see a child suffer from a condition that could have been prevented, and we certainly do not want those illnesses to be spread in our offices.

My practice is in Marin County, California – an area that is known for high rates of vaccine delay and vaccine refusal.  After much thought and careful consideration, my partners and I recently decided to change our policy related to immunizations.  Starting this spring, we will require that all patients age 2 and older be immunized with the measles, mumps, rubella (MMR) vaccine in order to remain patients of our practice.  We have a responsibility to protect the health of all of the children in our practice, and decrease the risk of vaccine-preventable diseases in our community. We have chosen to require the MMR vaccine because we are extremely concerned about the possibility of a measles outbreak in our community.

Vaccine preventable diseases are still a threat to the health of our children and our community.  In 2010, the pertussis (whooping cough) epidemic in California affected children in Marin County at eight times the rate seen in California overall, in part because of low immunization rates.  There was recently a case of mumps in a school-aged child in our county, and last year there was an outbreak of mumps in a dormitory at the University of California at Berkeley.  There have been measles cases and outbreaks associated with the 2012 Super Bowl, and in recent years in San Diego, Quebec, Indiana and Minnesota.  In 2011, there were 222 reported cases of measles in the US, the highest rate in 15 years.  Ninety percent of these cases were associated with air travel, but not all cases were in travelers.  Measles has become much more common in Western Europe, Africa, Asia and the United Kingdom due to dropping vaccination rates.  The CDC is already warning us that with the Summer Olympics in London and the Eurocup Soccer Championship in the Ukraine, the possibility of a US traveler to these countries coming back with measles is high.  Because of this, we are concerned that Marin County is at risk for a measles outbreak.

Because measles is so easy to spread, in order for a community to be protected from an outbreak, 95% of the population must be immunized.  Right now, the number of kindergartners in our county who are up to date on all of their vaccines is 83%, and there are schools and communities in Marin County where less than 50% of kindergarten students have had all of their required vaccines.   Certain areas in our community are clearly at risk of a measles epidemic.  In our practice, we have many children who are too young to receive the MMR vaccine as well as many children who have chronic illnesses that compromise their immune system and put them at risk.  This policy is meant to protect not only these children, but also our entire community from a measles outbreak.

We respect that the parents in our practice have the ultimate responsibility for making decisions about their children’s health care, but we have to weigh their personal decisions against the available data and the needs of our community.   In our practice, we feel strongly that communicating and collaborating with our patients and their families is the best way to provide excellent care.  We also feel strongly that vaccines save lives and that this policy protects our patients and our community from a preventable disease and all of its repercussions.

This essay is cited in the KevinMD record on vaccines.

Nelson Branco is a pediatrician who blogs at Survivor: Pediatrics.

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