This winter’s measles outbreaks appear to have gotten more attention in the press than it did among sales reps calling on primary care physicians.
“Physicians are making their own decisions,” says Darrell Rawlings, vice president, Rx Category and Program Management, McKesson Medical-Surgical. “They frequently look to their rep for product information or supplier information, but they are not looking for clinical opinions.”
“From a distributor’s standpoint, we can’t provide any medical guidance to our customers,” says Rick Nielsen, president and CEO, Lifeline Pharmaceuticals LLC, Miami, Fla. “We can, however, provide information about market trends or supply interruptions, and we can provide resources, such as educational materials on prescribing information.”
Midwinter outbreaks
In about a five-week period, from Jan. 1 through Feb. 6, 121 people from 17 states and Washington, D.C., were reported to have measles, according to the Centers for Disease Control and Prevention. Most of those cases were part of a large, multistate outbreak linked to the Disneyland theme park in Anaheim, Calif., though unlinked outbreaks occurred elsewhere as well.
Research conducted by a team at Boston Children’s Hospital and published online by JAMA Pediatrics indicated that vaccine coverage among the exposed populations was far below that necessary to keep the virus in check. By examining case numbers reported by the California Department of Public Health and current and historical case data captured by the Boston Children’s Hospital HealthMap disease surveillance system, the researchers estimated that the measles vaccination rate among the case clusters in California, Arizona and Illinois was between 50 and 86 percent, far below the 96 to 99 percent necessary to create a herd immunity effect.
Using the same data sources, the HealthMap team released a model illustrating how differing rates of vaccine coverage could affect the growth of a measles outbreak over time. The model suggests that if a population is fully vaccinated against the virus, one case of measles will give rise to only two additional cases over 70 days. By contrast, if only 60 percent of a population is vaccinated, more than 2,800 cases will occur over the same time period.
A commentary by Neal Halsey, MD, of Johns Hopkins Bloomberg School of Public Health, published on March 9 in the Annals of Internal Medicine, seemed to reinforce the researchers’ findings, suggesting that more measles outbreaks will occur because vaccine refusal has left enough individuals susceptible.
“The relative absence of measles in most areas of the United States for many years has led to an under-appreciation of measles-related complications and mortality, and unfounded fears about the association between vaccines and autism have contributed to vaccine hesitancy and the resurgence of measles,” according to the American College of Physicians, which publishes Annals. In his commentary, Halsey called for ramped-up efforts to focus on making sure all eligible U.S. children are vaccinated, and greater collaboration to increase vaccination internationally.
“Adult primary care clinicians can assist their pediatric colleagues in boosting community protection by routinely reviewing immunization records as they see patients who are transitioning from pediatric care, among other safety measures,” according to the Annals commentary. Physicians may also need to become familiar with clinical presentation of measles, since most practicing clinicians in 2015 will never have seen an actual case.
Just the facts
All the attention paid to the measles vaccine resulted in a spike of activity over the winter, says Rawlings. “To be quite frank, we’re essentially responding to increased activity more than anything else,” he says. “Much like on the flu side, the news of more outbreaks drives activity.”
In such instances, the rep’s role is to respond to that demand, not offer clinical guidance, he says. “They are there to represent the offerings of the company. It wouldn’t be wise to initiate a science discussion with a scientist.”
Says Nielsen, “Due to the recent media attention, we have seen an increase in [measles vaccine] sales in the last few months.” Another factor driving activity is vaccine manufacturers’ growing usage of social media and the Internet to communicate with physicians, parents of patients and even with patients directly, he adds. “That has changed the way information is flowing.” Though intended for physicians, that information is also available to the public who, in turn, are bringing up medical issues – including vaccination – to their doctors.
“From a distributor’s standpoint, we would fulfill the needs of the physician and recommend vaccines that may have a more natural form of introduction to the body, such as a subcutaneous or nasal administration,” he says. The distributor might also recommend vaccines that contain the least amount of toxins, resulting in the least amount of side effects.
As for the future? How will the public and the medical community view the outbreak of 2015?
“That really depends on how the states respond,” says Rawlings. “If there is some sort of legal activity that mandates some of this, that could change the game from a demand perspective, and we would respond as such.”