Expert Discusses Transparency and Education for the Current Measles Outbreak

Measles, a highly contagious viral infection, recently re-emerged as a significant public health concern, prompting health care professionals to reassess communication strategies and vaccination approaches. Despite decades of successful immunization programs, vaccine hesitancy and misinformation have challenged the medical community's efforts to maintain high vaccination rates and prevent potential outbreaks.

Crystal Hodge, PharmD, associate professor of pharmacotherapy at The University of North Texas Health Science Center at Fort Worth, provides critical insights into the complexities of measles prevention, vaccination strategies, and public health communication. Hodge goes beyond traditional medical advice, emphasizing the need for transparency, data-driven information, and a nuanced approach to engaging communities. By addressing vaccine effectiveness, potential complications, and the importance of informed consent, she offers a comprehensive look at how health care professionals can effectively combat measles and rebuild public trust in vaccination efforts.

Crystal Hodge discusses being transparent about adverse effects of the MMR vaccine and educating patients about measles. | Image Credit: Leigh Prather - stock.adobe.com

"We are in an information era where people have access to a lot of information, and so, I think directing people to appropriate resources is reasonable, but also making sure that we're being transparent because using statements like generally safe and effective, I don't think, work[s] as well with the general public like it used to," Hodge said. "It used to be that people kind of trusted us when we said that and our opinions on it, but now people want the data, and they want to make that decision for themselves."

Drug Topics: How can pharmacists educate patients about measles, its transmission, and the importance of vaccination?

Crystal Hodge, PharmD: This one's a tricky one. So I think one of the things that we're really learning is that transparency is really the most important. So, we are in an information era where people have access to a lot of information, and so I think directing people to appropriate resources is reasonable, but also making sure that we're being transparent, because using statements like generally safe and effective, I don't think work as well with the general public like it used to, right? It used to be that people kind of trusted us when we said that and our opinions on it, but now people want the data, and they want to make that decision for themselves. So, knowing that two doses of MMR can prevent about 97% of measles infection, I think is a great statistic to be able to provide, knowing that the vaccine schedule so the first dose is generally around 12-to-15 months; the second dose is between 4 and 6 years old. Even having 1 dose of the vaccine is about 93% effective during an outbreak scenario. One of the questions that people will often ask right now is, "Well, my child is not 12 months yet. Can they get the vaccine early?" for example, and I think that pharmacists can really help with that by saying, "You can get the vaccine as early as 6 months in an outbreak scenario. However, it won't count towards the 2-dose series." One of the things that we've learned in history is that we keep pushing the MMR vaccine back in timing; we should actually give it as early as 6 months. Now we give it around 12-to-15 months because we find that our [children] are able to mount a better immune response when they're a little bit older, and it tends to last longer. So if you do give it earlier, it doesn't count towards your vaccine schedule because it doesn't seem to be as effective. It's also helpful to know what pharmacists can and can't do in terms of pediatric vaccines. So, anybody who's 14 and up, pharmacists can go ahead and give those vaccines. If they're 13 or younger, you may need a prescription. It depends a little bit about where you're practicing. It's also helpful to know who's considered immune. So anyone born before 1957 is considered immune because they all probably got it at that point. There are some people who are not eligible for the vaccine, so pharmacists really need to be able to communicate who's not eligible for the vaccine. It's a live vaccine; anybody with a neomycin allergy, especially severe neomycin allergies, should not be getting the MMR vaccine. It's recommended to avoid in pregnancy, and then there's some caution in patients with thrombocytopenia or thrombocytopenic corpora, so those are some other things to think about, including vaccines, and then also be thinking about immunoglobulin prophylaxis, and then again, that transparency, talking about [adverse] effects. So try to avoid that generally safe and effective say, "Okay, you know, 15% or less of people will end up with a fever for a couple of days after," "up to 5% of people can sometimes have a transient rash. This is a live vaccine; that happens." So making sure that we're talking to people about what those [adverse] effects are going to be, including some of the more rare ones. So making sure that people are informed so that when they hear about things, they're like, "Oh yeah, my pharmacist told me about that," rather than "Oh, let me ask Dr. Google. Why did no one tell me about this? I didn't provide informed consent."

Drug Topics: What role can pharmacists play in ensuring accurate information about measles is disseminated to the public, especially in countering misinformation?

Hodge: So again, emphasizing that transparency piece, making sure that we're talking about not just the vaccines and the immunoglobulin prophylaxis, but also about the complications of measles itself. So measles, while a lot of kids will get measles and they'll be fine, people who tend to tolerate measles the best are about 5 years old to 19 years old. Anything less than 5, and our adults are more likely to suffer complications for measles, and so some of those complications could be pneumonia. They could be an ear infection, like otitis media, [or] diarrhea. There's actually a really good 2013 report from ACIP that goes over the history of measles, mumps, and rubella. I highly recommend that for any pharmacist who's trying to get a perspective on measles and some of the complications associated with measles, and that's a great resource to refer people to. There's also some data with malnutrition. So, if someone is malnourished and ends up with measles, they do have a higher case-fatality ratio, so that is something to pay attention to, and so I think that for pharmacists, one of the things to be considerate with, making sure there's accurate information and we're combating misinformation, is talking about what the complications of the infection are, talking about some of the complications of the vaccine, being aware of recommendations regarding isolation, support of care, and also being really precise with our language. I think that right now, we run into kind of concerns about are we talking about prevention, are we talking about treatment? Are we talking about supportive care? And the lines are kind of blurring depending on what resource you're looking at, but if we can be very precise with our language, maybe we can try to build up some of that trust again. So, for example, one of the things that's both supportive care and prevention is I really wish that the medical community at large, and particularly pharmacists, would recommend a healthy diet and exercise. That's really going to support a more robust immune system, so that if you've been vaccinated and you are otherwise [and] you've got a good immune system, your chances of fighting it off are really great, right? So having that healthy and diverse diet full of vegetables, so that you get natural dietary sources of vitamins and supplements rather than having to go to other [medications] or even things that are over the counter that can be really helpful in making sure that you have the robust immune system that can help you fight off infection.

Drug Topics: How can pharmacies collaborate with health departments during a measles outbreak?

Hodge: Measles is a reportable condition, and it should be reported to our health departments immediately. The health department, especially Texas, has testing that is available, and so if you go to their website, you can go there. They can actually help with contact tracing. They do have templates for triaging and exposure letters that are online. Something else that is helpful to know is that your health departments may also be aware of local immunization rates at schools, and so you can try to identify different communities that are at a higher risk. So for example, in the 2023-2024 report, the general Texas vaccination rate was about 94% in in kindergarteners, which is close to that 95% threshold, but then if you look at certain communities, some of them to drop well below that, so you can look at where you're living and what your local community looks like to see what your current vaccination rates are. Something else that can be helpful is promoting vaccination record keeping. So the WHO, or the World Health Organization, does have a certificate of vaccination prophylaxis card. It's a little yellow card. So if you do have a kid, or if you're an adult and you want to keep a record, I do recommend that because that one is accepted when you travel. There are other log books that are out there that can be used to help you keep a record for your immunizations, and then one of the things that most states do have now are actually vaccine registry systems, and so in Texas, that's called Immtrac2, and providers can upload vaccine records. I believe you do have to consent into that process, at least initially, but your providers can, whenever they give you an immunization, upload your records there and then, if you're, say, a young adult, because it was only implemented in the early 2000s and you're not sure what your vaccination record is, you can request it from Immtrac2, so that using those vaccine registry systems can be really helpful in making sure that you're vaccinated and you have those records and making sure that you are in contact with the health department.

Drug Topics: What do you believe are the most critical actions needed to control and prevent future measles outbreaks?

Hodge: So I think of this, and I think most of us do think of this as a 3-pronged approach of vaccinate, isolate, and educate. So vaccinate: if you're not vaccinated, try to avoid highly populated areas, areas with lots of kids, especially in the outbreak setting because you don't want to be exposed. I do recommend vaccination, if you are eligible for a vaccine. Again, not everyone is, but so we do have to be careful of that. If you are exposed, make sure that you're isolating, because again, that incubation period is about 2 weeks, and some people it can be up to 3 weeks, and so you want to try to avoid contact with others, especially people who are high risk for complications. So that's our really young kids, less than 5, especially infants, people with immunocompromised conditions or weakened immune systems, pregnant women, and then if you do develop a rash, particularly, make sure that you're staying home and isolating for at least 4 days. Then educate, educate, educate, so let's try to make sure that we're engaging our communities, not just people who are willing to listen either so making sure that we're engaging communities that aren't willing to listen, or maybe who are vaccine hesitant, and talking through those hesitancies, and let's try to stay away from those appeals to authority and saying that this is established science because that tends to turn people off who are who don't like that. So, let's try to talk about the data as it stands. Let's talk about the risk of [adverse] effects. Let's talk about risks of complications. What are the statistics? Making sure that we're really providing that informed consent process that's adaptive to this information era that we're currently in.

Drug Topics: Is there anything else you would like to add?

Hodge: The other thing I would say is that measles is not the only ongoing outbreak, and so I think that a lot of people have a little bit of fear because of COVID-19, and so they're seeing another outbreak, and they're like, "Oh, my God, is my world about to end?" And it's certainly something that is a public health concern, and we need to get a need to get ahead of it and control of it, but it's not the only outbreak. We're also seeing increasing rates of pertussis. We still have HIV. There are lots of different infections that we could have public health policy to try to help us decrease those infectious rates. We are also coming on respiratory virus season, so it's important to be thinking about how some of our viruses have a seasonal pattern to them, but regardless, basic hand hygiene [and] basic hygiene in general, is really helpful. So cover your nose when you sneeze, your mouth when you cough, those basic things can be really helpful. Vaccinating your community and having that herd immunity is really helpful, and then again, just really trying to emphasize that we need to be talking to each other, and we need to be engaging in good faith ways, including a lot of transparency, and really trying to stand on the merits of science that currently exists and being transparent about what we know, what's our opinion, what we hypothesize, and what we can do to find answers together because there's a lot of research that's still needed, and so we really want to make sure that we're engaging the community to say, "Okay, let's do the research together. Let's enroll in clinical trials. Let's try to find out what we do and don't know. What's our current theories, and let's see what the current answers are."

READ MORE: Infectious Disease Resource Center

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