Health experts caution against dipping into illness risk zones for the holiday season

There’s a double-edged line that American public health officials are drawing about celebration season. On the one hand, there’s an important message to send to parents who don’t vaccinate their children: Get them vaccinated, it’s the law and there’s nothing to gain but put their children at greater risk of serious illness and premature death. On the other hand, there’s the clear preference to invite people who want to join you at your annual picnic — especially children, and especially kids who may have been immuno-compromised.

All Americans will feel an impact of measles, mumps and rubella outbreaks next year, said Dr. Linda Reverby, director of the [Thinking Foward Advancing Health] think tank that published a study last week on holiday conferences, hotel stays and the risks posed by measles and other communicable diseases. “Particularly people who don’t have kids, who are single people who need to meet new people, and families going on the holiday,” she said. And there’s a more personal thread for Reverby: “It’s annoying that something as major as measles [breaks], for a parent of a child with measles, it’s still irritating for a parent to not have him or her out and about when people around him or her are celebrating.”

Reverby and her coauthors looked at four national studies that captured responses from the U.S. hotel industry. They found that “45% of hotels found that holiday gatherings involving unvaccinated people created more risk for others than gathering with fully vaccinated people.”

The virus can spread easily at social gatherings, said Dr. Anne Schuchat, the director of the CDC’s National Center for Immunization and Respiratory Diseases. “The impact can be huge, even if the number of cases is relatively small.”

Health officials say there are certain key ways that health workers and policy-makers can best prepare for outbreaks, with the aim of limiting the health risks.

For example, in the U.S., health workers are often forced to go into communities where immunization rates fall below recommended levels to conduct the required “herd immunity” surveillance. There are no vaccines for measles — just five for chickenpox and several others for hepatitis B and mumps. To ensure that exposures occur on both sides of the coin, officials require that health workers interact with as many parents as possible at these meetings — that is, anyone who is unvaccinated or who chooses not to vaccinate their children. They recommend that health workers greet children who are not vaccinated or non-vaccinated, and make sure that they greet all children within their protection guidelines.

Care workers don’t just have to avoid shaking hands and greeting with common greetings such as hello — they have to make sure to only meet children who have been inoculated. All children should also be offered an introduction to washrooms and offered the opportunity to use a toilet to wash their hands, Dr. Schuchat said. It’s also important to install hand-washing stations at events, and to use bleach to sanitize surfaces. Some of these efforts are essential but not sufficient to keep virus-carriers away from shared environments.

Making hotels and other sources of holiday gatherings safer is often easier said than done, Dr. Schuchat said. In many hotels, people who are not vaccinated and who opt not to vaccinate their children won’t need to wear masks, and most won’t be in at least a set number of rooms, Dr. Schuchat said. Add to that, she said, the challenge of understanding who is susceptible to disease — whether they were vaccinated, or are in a community where cases are higher. “How can we assess the risk from people who aren’t vaccinated?” she said. Health officials are also trying to find ways to get families who may have been unvaccinated to rejoin a community so they can spread virus to those who are not.

How to deal with parents who choose not to vaccinate: Since not vaccinating children puts other people at risk, there’s certainly a benefit to inviting unvaccinated children who want to attend, Dr. Schuchat said. “Parents of unvaccinated children can feel good about getting their children in and out of their sight and travel with them,” she said.

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