How the Disneyland Measles Outbreak Affects Parents’ Views of the MMR Vaccine


The Disneyland measles outbreak, coupled with nurses addressing three objections, could change some parents’ anti-vaccine stance.

The last souvenir that anyone expects to get at Disneyland is the measles, but that’s what happened in late 2014. A measles outbreak started at the theme park in December, and the infectious disease has since spread to an ever-widening circle of people. As of March 20, there were 133 confirmed cases of measles in California residents as a result of the exposure.

Many are tracing the Disneyland measles outbreak to a growing anti-vaccine movement among parents which has led to lower levels of compliance with the MMR vaccine.

In fact, in a research letter published online on March 16 for JAMA Pediatrics, a group of researchers led by Maimuna Majumber, MPH, noted that “Substandard vaccination compliance is likely to blame for the 2015 measles outbreak.”

They wrote, “Our study estimates that MMR vaccination rates among the exposed population in which secondary cases have occurred might be as low as 50% and likely no higher than 86%. Given the highly contagious nature of measles, vaccination rates of 96% to 99% are necessary to preserve herd immunity and prevent future outbreaks.”

The California Department of Public Health reported on March 20, 2015, that among the affected people for whom they had documentation, 57 were unvaccinated.

The widespread attention generated by the measles outbreak has given vaccination advocates another opportunity to discuss the importance of childhood vaccinations like the MMR vaccine.

“I absolutely believe that it has helped the cause,” said Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP, a member of the executive board of the nonprofit health advocacy organization Every Child By Two and a member of Nurses Who Vaccinate.

“It’s raising awareness,” agreed Vicki Allen, RN, MSN, vice chairman of the Association for Professionals in Infection Control and Epidemiology’s (APIC’s) communications committee and the infection prevention coordinator at Beaufort Memorial Hospital in Beaufort, S.C.

A recent market research study by MarchPhoenix Marketing International found that 6 percent of the respondents could be called MMR “non-believers,” with a variety of reasons they’re not convinced of the importance (or safety) of the MMR vaccine. But the researchers also suggested that a growing number of non-vaccinators may be rethinking their position in the wake of the Disneyland measles outbreak.

Fortunately, nurses can do a great deal to educate parents and the public about childhood vaccinations--how they work, why they protect people from infection, how herd immunity works, etc.

“I would try to obviously provide information that’s scientifically-based, that’s evidence-based, that’s not opinionated and is from reliable sources,” said Allen.

Koslap-Petraco emphasized the value of being empathetic when talking to parents, especially if they’re on the fence about vaccinations. When you acknowledge that a parent might have concerns, it can diffuse some of the tension. They can be reassured that you are listening to them and that you are taking their concerns seriously.

“And I really believe that’s what the vast majority of parents are looking for,” she said.

She cited the mnemonic CASE, which stands for Corroborate, Advice, Science, and Explain--a communication model developed by the Autism Science Foundation’s Allison Singer to explain vaccine safety. And she will also refer to the fact that her own family members are all fully vaccinated.

“I’m not asking them to do anything that I’ve not done for my family,” said Koslap-Petraco, who has also served on the Immunization Action Coalition’s advisory board.

Here are some suggestions for responding to a parent’s concerns about childhood immunizations:

A parent’s concern might be:

How you can respond:


“I’ve heard the MMR vaccine causes autism.”

Explain that the original study that purported a link between autism and the MMR vaccine was retracted, and many new studies have shown there to be no link.


“Vaccines aren’t really that effective anyway” or “the diseases really aren’t that bad.”

Many people have never seen a case of the diseases prevented by the immunizations or the complications. Explain that vaccines have saved millions of lives and prevented many serious complications--for example, you could emphasize that the MMR vaccine has prevented the deaths of many children as well as serious conditions like measles-related encephalitis.


“Isn’t it better to space all the vaccines out?”

Explain that scientists worked to develop a schedule that would give children the earliest possible protection--and that each vaccine dose is scheduled to be given at the best age for the immune system. The schedule takes into account that several doses of some vaccines are necessary to give a child the maximum protection--and they are spaced out appropriately.

Nurses can refer to this American Academy of Pediatrics resource for additional guidance on immunization schedules.

Some health care professionals are willing to meet reluctant parents halfway and space out the vaccinations--even though it’s not necessary--if it means the parent will allow the child to get fully vaccinated.

“It would certainly be better than having their child not protected by a vaccine,” said Allen.

But as Koslap-Petraco noted, it’s not ideal. “The problem with delayed vaccinations is delayed protection,” she said.

Allen emphasized that it’s important for nurses to continue to provide sound evidence to parents about childhood vaccinations. Nurses can also help other health care providers by sharing what they know, including any good resources that they may discover.

And don’t give up, said Koslap-Petraco.

“I just think that using empathy with them and identifying with them and continuing to tell the stories to them gives me a chance of getting through to them,” she said.

By Jennifer Larson, contributor

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