With measles cases reaching record highs in 2019, experts answer the questions many parents are probably wondering.

By Sarah Bradley
Caitlin-Marie Miner Ong

As a parent, it's easy to worry about the measles outbreaks and cases sweeping through New York, Washington, and 13 other states.

The Centers for Disease Control and Prevention announced there were 387 cases of measles in the United States from January 1 to March 28 in 2019 alone—that's more cases than there were in all of 2018 when 372 cases were reported. It's also the second-highest number of reported cases since 2000, the year measles was declared eliminated from the United States. (There were 667 cases in 2014.)

It's scary stuff, for sure, and all the talk about outbreaks might have you thinking twice about the people your own kids spend time around—especially in close quarters.

Should you keep unvaccinated kids away?

While vaccines play a crucial role in maintaining herd immunity and preventing the spread of illness, they aren't 100 percent effective; there's still a small chance your fully immunized child could catch the measles if they were exposed to the extremely contagious virus.

So...you should basically start screening your kiddo's friends for up-to-date vaccinations at the door before letting them inside your house, right?

Experts say that extra layer of protection isn't necessarily a step you need to take. "I tell people with these concerns that there are children in your child's class that are not vaccinated or partially vaccinated, and you have no right to be made aware of that because of HIPAA (medical privacy) regulations," says Gary Kramer, M.D., a pediatrician in Miami, Florida. "Your kids will be around unvaccinated kids everywhere, unbeknownst to you."

While it's tempting to want to keep your home a controlled, contagion-free environment, it's not necessarily where you should focus your efforts. Instead of stressing over keeping unvaccinated kids out of your home, says Kramer, your best bet at protection lies in making sure you are all up-to-date on recommended vaccinations.

There is one important exception to that, however. "The most important thing to consider is whether anyone potentially exposed to the unvaccinated child could be susceptible to any of the diseases that particular child may be able to transmit," says Stan Spinner, M.D., chief medical officer and vice president at Texas Children's Pediatrics and Texas Children's Urgent Care.

For example, infants are not able to receive the first dose of the measles, mumps, and rubella (MMR) vaccine until they are at least 12 months old, so babies under one year of age are highly susceptible. And even with proper vaccinations, elderly adults and immunocompromised people (like those on steroid or cancer treatments) are also more vulnerable to illness. If you have anyone living in your home who falls into one of these categories, you should seriously consider setting stricter rules about who is allowed to visit.

Otherwise, says Spinner, the risk of a healthy, fully immunized individual getting infected from exposure to an unvaccinated individual is low. But, obviously, the risk is never zero—and both experts agree that parents need to evaluate their own comfort level each time they're presented with this scenario.

How to start a vaccination convo

If you decide that you're ultimately not comfortable with having an unvaccinated child at your house, you'll have to broach the subject with that child's parents. It's understandable to be intimidated by the thought because these kinds of conversations can be awkward and may instantly put people on the defensive. Thankfully, it doesn't have to be a situation wrought with drama or confrontation.

"The best approach is to be direct about your concerns without judgment," says Kramer. "There's a big movement of shaming people today, but it just doesn't help—no one likes to be shamed."

Instead of slinging accusations, Kramer says to honestly express your personal fears about vaccine-preventable illnesses. Try saying something like, "This is a real concern of mine, though I know not everyone shares it," or "I respect the choices that you're making for your children, but this is the choice I'm making for mine."

If the parents of the unvaccinated child respond by saying their child isn't sick so you don't have to worry, you have reason to stand your ground: with many illnesses, people can be contagious before they begin showing symptoms and for a time after starting to feel better, too. So your child could catch an illness from a seemingly healthy person, making it nearly impossible to thoroughly screen people for illness.

At the end of the day, your decision may or may not be met with understanding. In an ideal world, the vaccine conversation would start to become more and more commonplace, in the same way that experts recommend talking to your child's friend's parents about food allergies and guns in the home while arranging playdates.

"I believe parents need to be comfortable asking [about vaccinations]," says Spinner. "Protection against vaccine-preventable diseases is not only important for your child, but also for others. Even for parents of healthy, fully immunized children, opening up this dialogue may encourage vaccine-hesitant parents to decide to vaccinate their children."

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