“Show-Me” Vaccines

Lara Kerwin, PharmD Candidate 2015, UMKC School of Pharmacy

Lara Kerwin, PharmD Candidate 2015, UMKC School of Pharmacy

As a Kansas City (K.C.) native, I take pride in my hometown for several reasons:

1)     The Kansas City Royals are off to a great start this year! We fiercely love our Royals and root for them, no matter what.

2)     Two Sporting K.C. players are on the U.S. National soccer team this year and made key plays in our win over Ghana for the U.S. to remain in contention for the 2014 F.I.F.A. World Cup.

3)     Our barbeque, entertainment, and picturesque fountains are second-to-none. K.C. is a great place to live that offers the bustle of the city, quiet suburbia, and beautiful rural areas all wrapped into one.

Despite all of these amazing attributes of Kansas City, I heard news this week of home that left me feeling uneasy. As of June 9, The Kansas City Star reported 13 cases of the measles in town, along with two other suspected cases.1

As a Kansas Citian, certified immunizer, and future pharmacist, I was disheartened when reading this news because measles are a vaccine-preventable disease.

Once contracted, measles can lead to a whole body rash, fever, and even neurologic symptoms and death.2 Measles outbreaks, however, are not isolated to the Kansas City area. Several recent reports from the Centers for Disease Control and Prevention (CDC), including the Morbidity and Mortality Weekly Report from June 6, 2014, mention that there have been 477 cases of the measles reported in 20 states (including Missouri) between January 1 and June 13 this year alone.3 Also stated in these reports, “The majority of the people who got the measles were unvaccinated.” 2

The measles were eradicated in the United States back in 2000, so these outbreaks are raising serious concerns for the public.3 The CDC posits two reasons why the measles are making a comeback.

One, the measles is still endemic to other countries, so travelers from these regions are bringing the measles virus into the United States.

Two, people traveling to these endemic measles regions are not getting the necessary travel vaccinations or have never received the vaccine and become exposed.3

In a statement to The Star, the director of the Johnson County Department of Health and Environment declared, “The best way to prevent measles is what we have known for years; make sure that you and your children are up to date on your vaccinations.” 1

This got me thinking: Why are people not receiving these vaccines? The answer is multi-fold. Some avoid immunizations because of religious beliefs or ideals. However, others fear a link between vaccines (namely, MMR) and autism due to a plethora of misinformation.4 In 1998, a doctor from the U.K. purported a causal relationship between the measles-mumps-rubella vaccine and autism by way harmful, neurotoxic proteins entering circulation via MMR-induced irritable bowel disease.5 Since its original publication in The Lancet, it was released that this doctor did not reveal several conflicts of interest pertaining to his assertions about the MMR vaccine; his medical license has since been revoked, and The Lancet retracted the article in 2010.4 All the while, countless studies have found everything to the contrary of that original article: there is no causal link between the MMR vaccine and autism.5

Similarly, the evidence suggests that thimerosal, a preservative found in some multi-dose vaccine vials, does not cause autism, either. To further discredit the misinformation about MMR vaccines, the MMR vaccine does not and has never contained the thimerosal preservative).4, 5 In a newsletter addressing “Vaccines and Autism: What you should know,” the Children’s Hospital of Philadelphia decisively states, “… [D]elaying or withholding vaccines will not lessen the [autism] risk; it will only increase the period of time during which children are at risk for vaccine-preventable diseases.”5

The recent measles outbreaks across the United States, including Missouri, provide pharmacists with an opportunity to re-educate their patients on the importance of childhood, traveling, and catch-up immunizations, as well as an opportunity for pharmacists to expand their scope of practice.

This year in the Missouri state legislature, the Senate passed bills that supported by the Missouri Pharmacy Association and others about pharmacists providing immunizations. S.B.754 now provides that pharmacists in the state of Missouri can administer Hepatitis A, Hepatitis B, and Tdap in addition to influenza, pneumococcal, meningococcal, and zoster under protocol.6,7 This increases access to convenient care for patients who do not have a primary care provider. The bill also will protect against more vaccine-preventable diseases for Missourians. However, the aforementioned vaccines administered by pharmacists are restricted to patients aged twelve and older, and the bill does not provide for pharmacists to administer the MMR vaccine.8

Why does this matter? Nearly 30% of the measles outbreak cases were in people under the age of 19 (137/477).2 Presently, 27 states allow pharmacists to administer vaccines to patients under the age of 12, while 26 states ubiquitously allow pharmacists to administer every vaccine (including MMR).9 Therefore, precedent exists for pharmacists to be able to give the MMR vaccination to populations of all ages. But without proper legal provisions, Missouri pharmacists cannot actively provide these immunizations.8

What can Missouri pharmacists do in lieu of these measles outbreaks? According to pharmacist Mitchel Rothholz, RPh, MBA and chief strategy officer of the American Pharmacists Association (APhA), pharmacists must strive for the “Immunization Neighborhood.” 9 This concept includes advocating for immunizations through providing education and motivation for our patients and facilitating immunizations by inviting authorized immunizers into our pharmacies.9 If pharmacists honor the initiative, vaccine-preventable disease can be by and large eliminated.4 By “collaborat[ing], coordinat[ing], and communicat[ing]” with key players, the “Immunization Neighborhood,” concept can be achieved to meet the health needs of surrounding communities.9

Reimbursement plans for these services, as well as our current lack of provider status federally, may initially preclude Missouri pharmacists from providing the MMR vaccine.9 However, Missouri pharmacists can still play a definitive key role in resolving this health crisis. By correcting misinformation about vaccines, practicing at the top of their licenses with the implementation of S.B. 754, and continually advocating for increased access to care by way of expanding the scope of pharmacy practice, Missouri pharmacists can do their part to restore the health and safety of our Missouri hometowns and communities.

Lara Kerwin
UMKC School of Pharmacy
Pharm.D. Candidate 2015
MPA Rotation Student, June 2014

 

Sources

  1. Bavley A. KC area now has 13 measles cases, all apparently linked. The Kansas City Star. June 9, 2014.
  2. Centers for Disease Control and Prevention (CDC). Measles – United States, January 1 – May 23, 2014. Morbidity and Mortality Weekly Report Early Release. http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.pdf June 6, 2014;63(22):496-9. Accessed June 17, 2014.
  3. Centers for Disease Control and Prevention (CDC). Measles Cases and Outbreaks, January 1 to June 13, 2014. http://www.cdc.gov/measles/cases-outbreaks.html June 16, 2014. Accessed June 17, 2014.
  4. Hensley E and Briars L. Closer look at autism and the measles-mumps-rubella vaccine. J Am Pharm Assoc. 2010;50:736-741.
  5. The Children’s Hospital of Philadelphia Vaccine Education Center. Q&A Vaccines and Autism: What you should know. http://www.chop.edu/export/download/pdfs/articles/vaccine-education-center/autism.pdf 2012;2. Accessed June 17, 2014.
  6. Missouri Senate. 97th General Assembly. Second Regular Session [Truly Agreed to and Finally Passed] Conference Committee Substitute for House Committee Substitute for Senate Substitute No. 2 for Senate Bill No. 754. http://www.senate.mo.gov/14info/pdf-bill/tat/SB754.pdf 2014. Accessed June 18, 2014.
  7. Missouri Board of Pharmacy. Immunization FAQ. http://pr.mo.gov/boards/pharmacy/SECURED_Immunization%20Brochure_10-6_.pdf Revised October 30, 2014;1-4. Accessed June 17, 2014.
  8. Carnahan R and Kander J. Rules of Department of Insurance, Financial Institutions, and Professional Registration. Division 2220 – State Board of Pharmacy, Chapter 6 – Pharmaceutical Care Standards. Code of State Regulations. http://www.sos.mo.gov/adrules/csr/current/20csr/20c2220-6.pdf April 30, 2013;1-11. Accessed June 17, 2014.
  9. Rothholz MC. The Role of Community Pharmacies/Pharmacists in Vaccine Delivery in the United States. [PowerPoint]. Atlanta, GA: CDC Advisory Committee on Immunization Practices (ACIP); 2013. Accessed June 18, 2014.

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