The rural isolation of Martha’s Vineyard and its attraction for tourists from around the world, coupled with the Island’s higher-than-average number of unvaccinated children, heighten the risk of a disease outbreak within the general population. Dr. Vandana Madhavan, a pediatric infectious-disease specialist at Massachusetts General Hospital (MGH), will describe the importance of childhood immunizations in a presentation that begins at 10 am Saturday in the mural conference room off the main lobby, in conjunction with the Martha’s Vineyard Hospital Health Fair.
Dr. Madhavan works in the MGH inpatient consultation service and outpatient clinic, and serves as a pediatric hospitalist and primary care physician. Her presentation on vaccines and immunizations comes against the backdrop of a recent measles outbreak linked to visits to Disneyland last December, following years in which the disease appeared to be disappearing.
Cases had become rare in the U.S. after almost 15 years of universal inoculation with the highly effective measles/mumps/rubella (MMR) vaccine. In recent years, however, some parents have chosen to delay or opt out of state-recommended vaccine schedules, based on a disproven study that linked vaccinations to autism.
“On Saturday, I will be focusing on measles — the disease itself, vaccine protection/herd immunity concepts, the current outbreak — and then a more general discussion about the importance of timely and complete immunizations in children, as well as adults,” Dr. Madhavan said in an email to The Times.
Measles was declared eliminated in the United States in 2000, which meant it was no longer native to the United States but continued to be brought in by international travelers.
The Centers for Disease Control (CDC) reported that since 2001, the number of cases had topped 100 only five times, and there were more than 200 cases in 2011. However, the number spiked to 644 cases in 2014.
In January of this year, 102 people in 14 states were reported to have contracted measles, and most of those cases were connected to a large, ongoing multistate outbreak linked to Disneyland.
Most of those cases occurred in California, and involved nonvaccinated people, according to a Reuters report published March 4. All states allow medical exemptions with strict and clear standards, such as for health conditions that would preclude vaccinations. Some, including California, also allow philosophical and religious exemptions. Mississippi and West Virginia are the only states that allow exemptions for medical reasons only.
In all, 10 of the 17 states with reported measles cases allowed parents to opt out of vaccines on philosophical grounds, creating a far easier way out of immunizations than states that only exempt families with extensively documented religious objections or health conditions.
Massachusetts law requires vaccinations against 14 communicable diseases, including the MMR vaccine, as a condition of enrollment in public schools. In addition to medical exemptions, Massachusetts allows exemptions on religious grounds.
On Martha’s Vineyard, approximately nine percent of parents seek and receive exemptions from vaccinations for their children, six times the state average for students entering kindergarten. The Martha’s Vineyard Public Schools granted 12 medical exemptions and 191 religious exemptions, according to statistics compiled for October 2013.
With regard to her practice, Dr. Madhavan said she has not observed a significant increase in the number of parents who choose not to have their children immunized over the past several years.
“Parents choosing not to vaccinate tend to cluster, and choose certain providers who are previously known to be more amenable to taking care of unvaccinated children or those on alternate schedules,” she said.
“With my infectious disease background, and due to my working in a hospital-based practice, I personally have not seen this trend.”
Dr. Madhavan added, “However, I would say that there is an increase in parents asking about delaying and/or spreading out vaccinations, rather than declining them outright.”
For more isolated or rural communities such as Martha’s Vineyard, there are risks to the general population associated with parents’ choices regarding their children’s immunizations, Dr. Madhavan said.
“As under- and unvaccinated children and their families tend to cluster, communities with lower rates of immunization are more likely to experience an outbreak if there is exposure to a particular infectious disease that they are not protected against,” she said.
While an outbreak could be more easily contained in an isolated area, Dr. Madhavan said, access to necessary medical care and specialists might be lacking.
“Martha’s Vineyard has the added complication of being isolated as an island but also being quite open; travelers from all over the U.S. and the world might be at risk of exposing the population to disease,” she said.
Since the Disneyland measles outbreak, six of the 10 affected states with easy-opt-out laws have proposed new legislation. Oregon is considering banning most nonmedical immunization exemptions, and Washington, California, and Vermont are considering similar bills that remove personal, religious, and/or philosophical exemptions, according to news reports.
“I am not aware of any specific Massachusetts legislation to this effect, though it is certainly an important issue to address,” Dr. Madhavan said.
In addition to her pediatric clinical duties at MGH, Dr. Madhavan said, she is very involved in residency education. She also is one of two pediatric clinical leaders helping in the hospital’s transition to a new electronic medical record system next year, and works in quality and safety for the infectious disease division.
Dr. Madhavan received an A.B. from Harvard University and an M.D. from the University of Virginia School of Medicine in 2002. She completed her pediatric residency and chief residency at MGH for Children, followed by a pediatric infectious-diseases fellowship at Boston Children’s Hospital. She also concurrently completed a Harvard Pediatric Health Services Research fellowship, and earned a master’s of public health degree from the Harvard School of Public Health.