Tag: meningococcal outbreaks

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

Can you guess what happens when you ask for advice about vaccines in an anti-vaccine Facebook Group?

Meningitis is not a side effect of vaccines.

What could go wrong?

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

While most of us are used to hearing about meningococcal meningitis being a big risk for teens and young adults, it is important to realize that rates of disease are also high for infants, with a second peak during adolescence.

The highest rates of meningococcal disease occurs during infancy and adolescence.

So why don’t we routinely vaccinate infants against meningococcal disease?

Many countries do, including Australia and the UK, and in the United States, high risk infants are vaccinated against meningococcal disease.

If you were on the fence but were advised by your paediatrician (Australian spelling) to get vaccinated and protected because a child in your town had just died, would you get vaccinated?

Or would you listen to folks in an anti-vaccine Facebook group who tried to convince you that meningitis was actually a side effect of getting vaccinated?

Folks who insist that deaths from vaccine-preventable disease aren’t real and that instead, they are actually vaccine-injuries?

We know what happens when you ask for vaccine advice in an anti-vaccine Facebook group. The members push their propaganda to scare you away from vaccinating and protecting your kids.

Don’t listen to them. Vaccines are safe and necessary.

More on When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

Vaccine-Preventable Diseases – Year in Review 2018

Does it seem like we are moving in the wrong direction?

The eradication of smallpox shows just what vaccines can do!
The eradication of smallpox shows just what vaccines can do!

No, smallpox isn’t coming back, but many other vaccine-preventable diseases are.

Vaccine-Preventable Diseases – Year in Review 2018

With the availability of new vaccines and the expanded use of other vaccines, many of us were hopeful of the progress that was being made against vaccine-preventable diseases so far this decade.

Remember, it was just four years ago that the WHO certified India as a polio free country. And after years of declining numbers of wild polio cases, 2018 will be the first year with a higher number of cases than the previous year.

This hasn’t been a good year for measles either. The WHO Region of the Americas has lost its status as having eliminated measles!

In Bolivarian Republic of Venezuela, endemic transmission of measles has been re-established, with spread to neighbouring countries. As a result, the Region has lost its status as having eliminated measles. The Regional Technical Advisory Group, which met in July 2018, emphasized the importance of Regional action and an urgent public health response to ensure re-verification of measles elimination in Bolivarian Republic of Venezuela.

Meeting of the Strategic Advisory Group of Experts on Immunization, October 2018 – Conclusions and recommendations

After years of declining rates, global measles cases and deaths began to jump in 2017, a trend that continued in 2018.

“Outbreaks in North America and in Europe emphasize that measles can easily spread even in countries with mature health systems. Due to ongoing outbreaks, measles is again considered endemic in Germany and Russia.”

2018 Assessment Report of the Global Vaccine Action Plan

And no, this isn’t just a problem in other parts of the world.

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

More cases in other parts of the world mean more cases in the United States because unvaccinated folks travel out of the country and bring these diseases home with them, getting others sick.

But it wasn’t just measles outbreaks, including the second largest number of cases in 22 years, that we were seeing in 2018:

  • chicken pox – although the 41 cases involving a North Carolina Waldorf school got the most attention, there were at least 6,892 cases of chicken pox last year, which continues to trend down from recent highs of over 15,000 in 2010
  • hepatitis A – clusters of outbreaks in 15 states with at least 11,166 cases, many deaths, with exposures at popular restaurants
  • mumps – from recent highs of over 6,000 cases the last few years, we were “back down” to just over 2,000 mumps cases in 2018
  • pertussis – cases were also down in 2018, with a preliminary count of about 13,439 cases last year
  • meningococcal disease – isolated outbreaks continued last year, with cases at Smith College, Colgate University, and San Diego State University

And of course, we had one of the worst flu seasons in some time last year, with 185 pediatric flu deaths.

Fortunately, there were no cases of diphtheria, neonatal tetanus, polio, or congenital rubella syndrome. At least not in the United States.

Why are some disease counts down when so many folks say the anti-vaccine movement is more active than ever?

Remember, the great majority of people vaccinate and protect their kids!

And vaccines work!

It is best to think of the anti-vaccine movement, which has always been around, as a very vocal minority that is just pushing propaganda to scare parents away from vaccinating and protecting their kids.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad these diseases are, allow themselves to be influenced by anti-vaccine propaganda, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Also remember that many of these diseases occurred in multi-year cycles in the pre-vaccine era. When an up year hits a cluster of unvaccinated kids, we get bigger outbreaks. And then more folks get vaccinated, starting the cycle all over again. At least until we finally get the disease under better control or finally eradicated.

Want to avoid getting a vaccine-preventable disease this year?

Get vaccinated and protected and encourage everyone else to get vaccinated too.

More on Vaccine-Preventable Diseases – Year in Review 2018

Is the Meningococcal Vaccine More Dangerous Than Meningococcal Disease?

No one who has ever seen a child with meningococcal disease would ever think that it was even remotely possible that getting a meningococcal vaccine was more dangerous than getting the disease.

“The case-fatality ratio of meningococcal disease is 10% to 15%, even with appropriate antibiotic therapy. The case-fatality ratio of meningococcemia is up to 40%. As many as 20% of survivors have permanent sequelae, such as hearing loss, neurologic damage, or loss of a limb.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

Of course, that doesn’t stop anti-vaccine folks from spreading misinformation about these vaccines to try and scare parents away from vaccinating and protecting their kids.

Is the Meningococcal Vaccine More Dangerous Than Meningococcal Disease?

We actually vaccinate against meningitis with many different vaccines, including Hib, Prevnar, MMR, and the meningococcal vaccines.

And there are different types of meningococcal vaccines, including those that protect against Neisseria meningitidis serogroups A, C, W, Y and Men B.

Meningococcal vaccines are safe and effective against meningococcemia and meningococcal meningitis, both terrible diseases.
Meningococcal vaccines are safe and effective against meningococcemia and meningococcal meningitis, both terrible diseases.

So routine vaccinations likely prevent up to 500 meningitis deaths each year, just in the United States, including many deaths from Hib meningitis, pneumococcal meningitis, and meningococcal disease.

“During 2005-2011, an estimated 800-1,200 cases of meningococcal disease occurred annually in the United States, representing an incidence of 0.3 cases per 100,000 population.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

What about the idea that 1 in 100 people will have a serious reaction to the vaccine?

“The most frequently reported adverse events for MenACWY-D include fever (16.8%), headache (16.0%) injection site erythema (14.6%), and dizziness (13.4%). Syncope was reported in 10.0% of reports involving MenACWY-D. Of all reported MenACWY-D events, 6.6% were coded as serious (i.e., resulted in death, life-threatening illness, hospitalization, prolongation of hospitalization, or permanent disability). Serious events included headache, fever, vomiting, and nausea. A total of 24 deaths (0.3%) were reported.”

Epidemiology of Vaccine Preventable Diseases (PinkBook)

The serious events listed above were from the clinical trials for the vaccine and didn’t differ between the vaccine and placebo.

Although meningococcal vaccines can have frequent mild side effects, they very rarely have serious side effects.

Not everything that happens during a clinical trial is related to the vaccine, even though it still gets reported. Another Menactra trial reported no deaths and the serious adverse events that were reported weren’t related to getting vaccinated.

Here is another meningococcal study in which a few of the participants died – one in a car accident and the other a drug overdose.

These deaths were not related to getting vaccinated, but were listed because they occurred during the study.
These deaths were not related to getting vaccinated, but were listed because they occurred during the study.

Unfortunately, vaccines can’t protect you from everything…

It would be especially nice if they could protect us from bad anti-vaccine memes.

More on Meningococcal Vaccine Safety

Vaccine Requirements for College Entry

Most of our kids are up-to-date on their vaccines by the time they are ready to start college.

That’s likely why few of us give college vaccine requirements much thought.

Will this chicken pox outbreak in Ohio spread?
Will this chicken pox outbreak in Ohio spread?

But maybe it is something we should start thinking about more, as it seems that many colleges do not have actually require their students to be vaccinated and protected!

Vaccine Requirements for College Entry

The one vaccine that is the most often associated with going to college is the one that protects our kids against meningococcal disease.

That’s actually two vaccines though:

  • MCV4 – Menactra or Menveo
  • MenB – Bexsera or Trumenba

Which other vaccines should kids get before going to college?

They should get whatever vaccines they might have missed when they were younger, including MMR, chicken pox, hepatitis A, hepatitis B, Tdap, HPV, and polio vaccines.

Plus they should get a flu vaccine every year.

Vaccine Recommendations for College Entry

Unfortunately, in many cases, instead of requirements to attend college, we really just have recommendations that students can choose to ignore.

What’s the likelihood that your fellow students are vaccinated and protected?

How many are unvaccinated?

Which school do you plan on attending?

“Immunizations are recommended to protect your health and the health of others, but they are not required by the university.”

Welcome to the University of Michigan!

Fortunately, most schools do require at least some vaccines.

In addition to either Menactra or Menveo, many require two doses of MMR.

Some also require three doses of hepatitis B vaccine.

A few, like the University of Michigan and the University of Wisconsin don’t require any vaccines though.

These are the ten of the biggest colleges in America, at least in terms of enrollment, and their immunization rules:

TdapMMRVarHepA/BMCV4MenBHPVIPV
OSU12
2X/31XX4
FlaR2RR/31RRR
Minn12XXXXXX
ASUR2XXRXRX
UTRRRR/R1XRX
UCFR2RR/RRRRR
A&MXXXX1XXX
MichRRRR/RRXRR
PSU
R2RR/RRRRX
WiscRRRR/RRX
RR

On the bright side, Ohio State University, with one of the largest combined graduate and undergraduate enrollment, has the strongest immunization requirements.

On the other hand, it is quite sad that many of the others either have weak requirements, only recommend (R), but don’t actually require many common immunizations for enrollment, or don’t even mention them (X).

Why don’t more colleges have stricter immunization requirements for enrollment?

It is likely that they haven’t caught up with the problem of parents skipping or delaying their kids’ immunizations.

“While many infectious diseases such as meningitis are rare, it is not uncommon for hundreds of students at a large university to contract the flu each season.”

Contagious on campus

Which brings us to a problem – how can colleges hope to control outbreaks well if they don’t even know which students are vaccinated or not, and so can’t easily quarantine unvaccinated students? They seem to manage mumps and meningococcal outbreaks, but neither are as contagious as measles or chicken pox. 

Do we really need to wait for more outbreaks on college campuses before we start requiring that kids be vaccinated and protected before going to college?

At the very least, can we at least start tracking vaccine-preventable disease rates in college kids, make flu deaths in college students reportable, and report vaccination exemption rates by college campus?

More on Vaccine Requirements for College Entry

How Do They Figure out Who Starts an Outbreak?

As we continue to see outbreaks of vaccine-preventable diseases in the post-vaccination era, it is important that these outbreaks be quickly contained.

But it is important to understand that these outbreaks don’t simply stop on there own. A lot of work goes into containing them.

Working to Contain an Outbreak

And that work containing outbreaks is expensive. Much more expensive than simply getting vaccinated.

For example, the total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC were calculated to be at least $394,448 and 10,054 personnel hours.

Why it is so expensive is easy to see once you understand all of the work that goes into containing an outbreak. Work that is done by your local health department as soon as a case of measles, or other vaccine-preventable disease, is suspected.

Work that, for a measles outbreak for example, includes:

  • initiating a case and contact investigation
  • quickly confirming that the patient actually has measles, including testing
  • assessing the potential for further spread – identifying contacts who aren’t immune to measles and are at risk for getting measles
  • isolating people with measles and quarantining contacts who aren’t immune to measles for at least 21 days after the start of the measles rash in the last case of measles in the area, including everyone who is intentionally unvaccinated
  • offering postexposure vaccination, a dose of the MMR vaccine within 72 hours of exposure to contacts who are not fully immune so that they can get some protection maybe don’t have to be quarantined
  • having targeted immunization clinics in the affected population, such as a school or church, to get as many people vaccinated as possible, even after 72 hours, so they have can be protected in the future

That’s an awful lot of work.

Work that continues until the outbreak officially ends.

Finding the Source of an Outbreak

Another big part of the work that goes on to contain an outbreak is identifying the source of the outbreak.

Was it someone who had recently been traveling overseas, a visitor from out of the country, or someone that was already part of an another outbreak?

Why is that so important?

If you don’t find the source of the outbreak, then you can’t be sure that you have found all of the people that have been exposed, and the outbreak might go on for an extended period of time.

And no, it is never shedding, a vaccine strain, or a recently vaccinated child that causes these measles outbreaks.

Anatomy of a Measles Outbreak

A closer look at the measles outbreak in San Diego, California in 2008 can help folks understand even better what happens during one of these outbreaks.

A 7-year-old who is unvaccinated because his parents have a personal belief vaccine exemption travels to Switzerland with his family.

A week after returning home from the trip, he gets sick, but returns to school after a few days. He then develops a rash and sees his family physician, followed by his pediatrician, and then makes a trip to the emergency room because he continues to have a high fever and rash (classic measles symptoms).

He is eventually diagnosed with measles, but not before eleven other children are infected with measles. This includes two of his siblings, five children in his school, and four children who were exposed at his pediatrician’s office.

It is not as simple as that though.

During this measles outbreak:

  • Three of the children who became infected were younger than 12 months of age, and were therefore too young to have been vaccinated
  • Eight of the nine children who were at least 12 months old were intentionally unvaccinated because they also had personal belief vaccine exemptions
  • About 70 children were placed under voluntary quarantine for 21 days after their last exposure because they were exposed to one of the measles cases and either didn’t want to be vaccinated or were too young
  • One of the infants with measles traveled to Hawaii, raising fears that the measles outbreak could spread there too

All together, 839 people were exposed to the measles virus.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.

At least one of them was a 10-month-old infant who got infected at his well child checkup, was too young to have gotten the MMR vaccine yet, and ended up spending three days in the hospital – time his parents spent “fearing we might lose our baby boy.”

The parents of this 10-month-old weren’t looking for a vaccine exemption and didn’t want their child to catch measles, a life-threatening, vaccine-preventable disease. Instead, they were counting on herd immunity to protect him until their child could be protected with an MMR vaccine. They were one of “those who come into contact with them” that got caught up in a decision of some other parents to not vaccinate their child.

The kids who are at risk and get a vaccine-preventable disease because they are too young to get vaccinated, have an immune system problem that prevents them from getting immunized or their vaccine from working, and the kids who simply didn’t get protected from a vaccine are the hidden costs of these measles outbreaks that we don’t hear about often enough.

What to Know About Finding the Source of an Outbreak

Without all of the hard work that goes into containing outbreaks, the outbreaks of measles, pertussis, mumps, hepatitis A, and other vaccine preventable diseases would be even bigger.

More on Finding the Source of an Outbreak

 

Understanding the Recommendations to Get a Men B Vaccine

A lot of folks, even some pediatricians, are still confused about the recommendations for the meningococcal B vaccines.

Remember, two vaccines, Bexsero and Trumenba, are approved to protect against serogroup B meningococcal disease.

The Men B Vaccine for High Risk Kids

There is no confusion about the recommendation that high risk kids should get vaccinated against meningococcal B disease.

“Certain persons aged ≥10 years who are at increased risk for meningococcal disease should receive MenB vaccine.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Persons Aged ≥10 Years at Increased Risk for Serogroup B Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2015

Who’s high risk?

In addition to microbiologists who work with the Neisseria meningitidis bacteria, you are considered to be high risk if you are at least 10 years old and:

  • MenB vaccines are routinely given during outbreaks on college campuses.
    MenB vaccines are routinely given during outbreaks on college campuses.

    have a persistent complement component deficiency, including inherited or chronic deficiencies in C3, C5–C9, properdin, factor D, or factor H

  • have anatomic or functional asplenia, including sickle cell disease, children with congenital asplenia, and children who’s spleen was removed (splenectomy) to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.
  • are taking the medication eculizumab (Soliris), which is used to treat two rare blood disorders, atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH)
  • could be exposed in a serogroup B meningococcal disease outbreak

And, if high risk, you should either get a 3 dose series of Trumenba or a 2 dose series of Bexsero.

Keep in mind that traveling is not usually a risk factor for Men B, but can be for the other meningococcal vaccines.

The Men B Vaccine for Healthy Teens

But what if you aren’t at high risk?

While teens should routinely get vaccinated with other meningococcal vaccines, Menactra or Menveo, that provide protection against serogroups A, C, W, Y,  the recommendation for Men B vaccination is more permissive.

“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015

When given to healthy teens who are not at high risk for meningococcal disease, both Bexsero and Trumenba can be given as a two dose series.

A Permissive Recommendation for Men B Vaccines

This permissive recommendation for Men B is what has got folks confused…

“The recommendation is labeled as “Category B,” meaning that individual clinical decision-making is recommended. A Category A recommendation means a vaccine is recommended for everyone in an age-group or risk factor group.”

ACIP endorses individual choice on meningitis B vaccine

So there is a recommendation for older teens to get vaccinated with the Men B vaccines, it just isn’t the clear cut, get the vaccine, kind of recommendation that we are used to. The recommendation instead says that you can get the vaccine if you want to be vaccinated and protected against meningococcal B disease.

And that’s where the confusion comes from, as over 75% of doctors don’t even know what a category B recommendation really means! That’s not surprising though, as the Advisory Committee on Immunization Practices doesn’t often make category B recommendations for vaccines.

So why did the Men B vaccines only get a permissive recommendation? After all, Bexsero is routinely given to all infants in the UK at 8 weeks, 16 weeks, and 1 year as part of their routine childhood immunization schedule.

Things that factored into the decision for a permissive recommendation seemed to include that:

  • routine vaccination of all teens would prevent about 15 to 29 cases of Men B and two to five deaths each year, as there are about 50 to 60 cases and five to 10 deaths each year in children and young adults between the ages of 11 and 23 years, and giving it only to kids going to college would only prevent about nine cases and one death each year
  • there are some concerns about how effective the MenB vaccines might be, but only because vaccine effectiveness “was inferred based on an immunologic marker of protection,” as it is difficult to otherwise test how well the vaccine works because the disease has a low prevalence and there is no data yet about how long the protection will last, as they are new vaccines. Still, from 63 to 88% of people get protective levels of antibodies after getting the MenB vaccines and the protection should last for at least two to four years.
  • data on safety was limited, but there were no “no concerning patterns of serious adverse events”
  • the vaccine likely won’t reduce the nasopharyngeal colonization by MenB bacteria, so might not contribute to herd immunity

If you are still confused, you will hopefully be reassured that a combination, pentavalent MenABCW-135Y meningococcal vaccine is in the pipeline and once available, will almost certainly be recommended for all teens, replacing the need to get separate meningococcal vaccines for protection.

Making a Decision About the MenB Vaccines

So do you get your kids the Men B vaccine series?

“Pediatricians are encouraged to discuss the availability of the MenB vaccines with families.”

AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older

The one thing that is very clear is that you should make your decision after talking to your pediatrician about the risks and benefits of getting vaccinated.

Although many people think that there is no recommendation for healthy teens to get a Men B vaccine, that isn’t really true. There just isn’t a recommendation for routine vaccination of all teens.

It is true that the Men B vaccines aren’t required by most colleges, although some are starting to require them, just like they do Menactra or Menveo.

“The treating clinician should discuss the benefits, risks, and costs with patients and their families and then work with them to determine what is in their best interest.”

AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older

What are the benefits? Your child doesn’t get Men B disease, a disease that is often life-threatening.

What are the risks? In addition to extremely rare risks that you can see with any vaccine, like anaphylaxis, there are the risks that the vaccine doesn’t work, as no vaccine is 100% effective, pain from the shot, or that your child is never exposed, so didn’t actually need the shot, since Men B disease is pretty rare.

“The CDC has estimated the risk of anaphylaxis is 1.3 cases/1 million doses following administration of any vaccine. Thus, the vaccine benefit from prevention of death from MenB disease is approximately equal to the risk of anaphylaxis from MenB vaccine administration.”

H. Cody Meissner, MD on MenB vaccines: a remarkable technical accomplishment but uncertain clinical role

Although thinking about it this way, the risk of anaphylaxis vs the benefit of preventing Men B deaths seems to be equal, remember that anaphylaxis is often treatable.

What are the costs? Men B vaccines are expensive, but are covered by insurance and the Vaccines for Children Program. Still, someone is always paying for them.

What other factors come into play? Some teens are getting caught up on their HPV vaccines and are getting a booster dose of the other meningococcal vaccine at around this same time. While they can certainly all be given together, some pediatricians prioritize getting kids vaccinated and protected with Gardasil and Menactra or Menveo, and so don’t focus on the Men B vaccines.

Still, the vaccine is safe and it works, so the question really may come down to – is it necessary? Or is Men B so rare, that it is worth taking a chance and skipping this vaccine.

What to Know About the Recommendations to Get a Men B Vaccine

Talk to your pediatrician and see if your child should get the Men B vaccine series.

More on Understanding the Recommendations to Get a Men B Vaccine

How to Avoid a Quarantine During an Outbreak at Your School

Believe it or not, hundreds of kids get caught up in quarantines for vaccine-preventable diseases in the United States each year.

Quarantines were routine in the pre-vaccine era.
Quarantines were routine during pre-vaccine era epidemics.

Wait, what?

Caught up in quarantines for vaccine-preventable diseases?

Then why do we have vaccines?

How to Avoid a Quarantine During an Outbreak at Your School

Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?
Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?

As you have probably already guessed, these aren’t usually vaccinated kids that are getting sick or quarantined in these outbreaks of measles, meningococcemia, and chicken pox, etc.

That’s right, they are unvaccinated.

Typically intentionally unvaccinated, although they are sometimes too young to be vaccinated or may have a medical exemption.

And that brings up to a few very easy ways to avoid getting quarantined during an outbreak:

  1. make sure you are always up-to-date on all of your vaccines
  2. if you think that you have natural immunity (already had the disease) or were vaccinated, but don’t have your immunization records, then getting a titer test might keep you out of quarantine if you can prove that you are immune
  3. get vaccinated, if possible, at the first sign of the outbreak, which might help you avoid quarantine in the case of measles and chicken pox

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That’s right, especially in the case of measles, you can often avoid being quarantined if you simply get vaccinated.

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are typically quarantined for at least 21 days.

Why are quarantines important?

Can’t you just isolate yourself if you get sick?

The problem with that strategy is that you are often contagious before you develop symptoms. That’s especially true of measles, when you likely won’t even realize that you have measles until you get the measles rash, after having a high fever for three to five days. That’s why people with measles are often seen at clinics and emergency rooms multiple times, exposing many people, before they are finally diagnosed. It is the classic signs of a rash with continued fever that helps to make the diagnosis.

Without quarantines of unvaccinated people, especially those who are known exposures to other cases, today’s outbreaks would be even bigger and harder to control.

If you don’t want to take the risk of being quarantined and missing weeks or months of school or work, then don’t take the risk of being unvaccinated. Tragically, that’s not the only risk you take when you skip or delay your vaccines. In addition to getting sick, you also risk getting others sick, including those who didn’t have a choice about getting vaccinated yet.

What to Know About Avoiding Quarantines During an Outbreak

The easiest way to avoid getting caught up in a quarantine for a vaccine-preventable disease is to simply make sure your kids are up-to-date on all of their vaccines.

More on Avoiding Quarantines During an Outbreak