Douglas Coupland once said, "Adventure without risk is Disneyland." However, he clearly wasn’t considering the health risks of high-volume amusement parks, like Disneyland. But, these places are a breeding ground for disease, as was made apparent by the recent measles outbreak stemming from the theme park.

The outbreak began in December and, to date, there are 119 confirmed cases in the country.

"As more people opt against vaccinating their children (or themselves), these childhood illnesses will become more prevalent again," Sarah Gaines-Hill, an infection control registered nurse in Anaheim, California, told MultiBriefs Exclusive.

"This occurrence is not a surprise, as this has been an event waiting to happen. Recent outbreaks in other countries [England, Germany, Pakistan] showed that the rally against vaccinations has consequences not yet identified in the U.S."

Current conditions in California

With diseases like the measles, a single case is not going to stir up national news — it might be significant, but health departments don’t consider it a threat until they have proof. Therefore, no action was taken until several cases were reported. Once the health department realized the extent of the exposure, they began informing the public.

Since the public became aware of this outbreak, obvious changes have occurred throughout the area. From individuals changing, or not making, plans to doctors’ offices calling unvaccinated individuals, it seems that most parts of life for those in affected areas have changed.

"Media reports of interviews with local Orange County residents has shown a change in planning for many," Gaines-Hill said. "People with young children or those unclear of their immune status have reported that they are choosing to not visit Disneyland Park at this time. Others are reporting that they are checking with their healthcare providers regarding immunity and booster vaccinations. Healthcare providers are taking pro-active steps to contact patients who need vaccinations to encourage them to get them."

Who is at risk?

Every healthcare professional in the United States needs to be prepared for the possibility that the outbreak could spread to their area. Not only are those who are unvaccinated or partially vaccinated at risk, even those who are vaccinated could be at risk.

According to the CDC, 95 percent of individuals who receive one dose of the vaccination are immune, and that increases to 99 percent with the second dose. However, this percentage can also decrease over time.

"Vaccinations given in early childhood can become less effective with age. Measles has not been an issue in the U.S. since 2002, therefore the drive to check for the need of booster immunizations has not been necessary," Gaines-Hill said.

Tips for preparing for the outbreak

Medical offices nationwide need to prepare for the outbreak. These offices should not wait until the first case in the area is diagnosed. "Why wait until the issue reaches your doorstep!?" stated Gaines-Hill.

Gaines-Hill offers the following suggestions to medical offices across the U.S.: "Signs should be posted at the medical office reception areas. Receptionists making appointments should have a standard checklist of questions to ask to rule out exposure. Patients seen with fever and rash should be masked at reception, and immediately roomed — not left in the waiting area. Finally, pull records of all patients under each provider to assess for vaccination/immunity status and create an outreach program to encourage vaccination updates.”

According to Kelly Welton, a respiratory clinical educator, medical offices and professionals should follow "what the CDC website says to do." They have the most up-to-date information and provide the most valuable information.

These tips will not prevent the spread of measles completely, but they will significantly reduce the risk of transmission.

If a possible case of measles turns into an actual diagnosis of measles, you must do everything in your power to stop the disease in its tracks. According to Gaines-Hill, "Follow your exposure control plan for notification of patients and staff in the office within the two-hour timeline of the patient visit."

The outbreak in the coming weeks

Since measles is so contagious, the likelihood of the disease spreading is significant. When Gaines-Hill was asked her estimate as to the extent of the outbreak, she stated: "This is dependent on the percentage of unvaccinated people…Based on the outbreaks in other westernized countries in recent years the extent could be greater than 1,000. For the U.S., we are just on the brink of a potential national epidemic."

When something major like this measles outbreak occurs, there are always long-term effects. One of the possible effects of this outbreak is an increase in parents vaccinating their children and vaccination programs in general.

"The concern for autism from vaccination programs has long been refuted, yet parents continue to hold onto this idea. Time for a new approach to public safety regarding opting out of vaccination programs that reduce the possibility of highly infectious and potentially fatal childhood diseases based on a whim," according to Gaines-Hill.

"Public education and a process to ensure vaccinations occur is necessary for public safety. The flippant attitude towards vaccination is afforded by the fact that responsible people use all preventive measures available to them resulting in ‘herd immunity.’ However, this complacency will no longer keep the public safe when more opt out of the program, than in."

Currently, medical professionals and the health department are unable to determine exactly how far this outbreak will spread. Individuals need to be aware of their risk for contracting the disease, and medical professionals need to inform their patients of the benefits of vaccinations and guide them in that direction. The best thing for medical offices to do in preparation is inform patients and maintain thorough records.