Recently, I've adapted the information I provide cancer patients about their risk of infection. Now I ask about their exposure to children, and whether or not the children in their lives are vaccinated against childhood diseases such as measles, mumps, pertussis, and chicken pox.
Washington and Oregon (the state where I practice) are among the states with the highest numbers in the country of parents choosing not to vaccinate their children, prompting this warning. While children have always posed an infection risk for cancer patients, the stakes become higher as fewer children are vaccinated. Contagious childhood diseases, once uncommon in the US, are now making a comeback. Incidents of measles are on the rise. Previously averaging 60 cases a year, usually occurring in children traveling to foreign countries, the number of cases nearly quadrupled in 2011 to 220. Pertussis (commonly known as whooping cough), mumps, and chicken pox are also on the rise, causing outbreaks in many states.
It's not the purpose of this post to debate the pros and cons of the "anti-vax" trend, but its existence is something that oncology nurses and their patients need to be reminded of. As more and more young adults are diagnosed with cancer, it's not only our elderly cancer patients who need to know whether or not the children in their lives are vaccinated. Young mothers or fathers diagnosed with breast cancer or testicular cancer have small children at home. Asking these patients if their children are vaccinated is part of assessing infection risks. If their children are vaccinated, they should be reminded that their children's playmates pose potential risk if they are not. For families choosing not to vaccinate, siblings and friends may pose increased risk to children diagnosed with cancer.
Measles start out with symptoms similar to a bad cold, such as a cough, runny nose, and fever. Highly contagious, by the time the rash is apparent, multiple exposures may have occurred. Cancer patients with neutropenia should be advised to avoid exposure to children. In emergency departments and physician waiting rooms, areas separating infectious patients from non-infectious patients are a sound practice, but respiratory droplets can travel several feet, making complete isolation difficult.
Have other members of TheONC found an increased risk to patients from childhood diseases? How are you advising patients? Has your practice of patient education changed to accommodate the anti-vaccination trend?