Recent outbreaks of measles in the U.S. have brought heightened attention to this highly contagious disease. Add to that the national dialogue about the pros/cons of immunization, and it is no wonder that camp programs have contacted the American Camp Association (ACA) for resources. ACA has partnered with medical and health professionals to provide the most up-to-date information available. This article will focus on three areas: immunizations, measles, and other communicable diseases.

 

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. A vaccine is a substance used to stimulate the production of antibodies and provide immunity against one or several diseases. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. Vaccines are prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease.

 

 

According to the Centers for Disease Control and Prevention (CDC), vaccines are the miracle of modern medicine. The CDC says that in the past 50 years, it’s saved more lives worldwide than any other medical product or procedure. In 1796, when Dr. Edward Jenner discovered vaccination in its modern form and proved to the scientific community that it worked, many embraced the concept. However, there was some fervent opposition as it became more widespread. People found it hard to believe that it really worked. They also felt that it took away people’s civil liberties, particularly when it was compulsory. Those debates continue to this day.

Vaccines are subject to licensure in the United States by the Food and Drug Administration (FDA) following studies that addressed safety and efficacy. With declining vaccine production capacity in the United States, Congress approved the National Childhood Vaccine Injury Act (NCVIA) in 1986. This comprehensive law established the National Vaccine Program within the U.S. Department of Health and Human Services to coordinate and oversee all activities within the U.S. government related to vaccine research and development, vaccine-safety monitoring, and vaccination activities. In addition, the Act established the National Vaccine Injury Compensation Program (VICP) to compensate for injuries associated with routinely administered childhood vaccines.

 

All 50 states have legislation requiring specified vaccines for students. Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons. Almost all states grant religious exemptions for people who have religious beliefs against immunizations. Twenty states allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs.¹

 

In recent years, state legislatures have considered numerous bills to either expand or restrict the personal belief exemptions. For example, in Washington, California and Vermont, parents who want to claim an exemption must now get a doctor’s signature. In 2013, Oregon passed a law that would require parents to obtain a signature of their primary care provider or watch an online educational video that presents information about vaccine risks and benefits.² 

 

With renewed debate about immunization, and the spread of diseases such as measles, a number of states are reconsidering their laws. As of February 2015, several states have introduced legislation that would address non-medical exemptions. 

 

• California SB 277 (leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277) would eliminate the personal belief exemption and require the governing board of a school district to notify parents or guardians at the beginning of the school term about immunization rates for the school in which the child is enrolled.
• Missouri H 846 (www.house.mo.gov/billsummary.aspx?year=2015&bill=HB%20846&code=R) would require parental notification if a non-immunized child is in attendance at the child’s school.
• New York A.B. 943 and SB 1536 — the “philosophical exemption to immunizations act” (open.nysenate.gov/legislation/bill/S1536-2015) would provide for a philosophical exemption.
• Vermont H 212 (legislature.vermont.gov/bill/status/2016/H.212) would remove the religious and philosophical exemptions to vaccinations.
• Washington HB 2009 (app.leg.wa.gov/billinfo/summary.aspx?bill=2009&year=2015) would remove the state’s current philosophical/personal belief exemption to immunization requirements.
• For information about each state’s requirements and exemptions, visit www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

 

Immunization and Camps

MEASLES

 

1. Know each camper and staff member’s immunization status. Require an immunization history (including month and year for each type of immunization) for each camper and staff member on the camp’s health history form. This is particularly important when illness associated with lack of immunization occurs. Understand your state’s exemptions from school immunization requirements as well. (See section below on immunization for more information.)
2. Decide if you will allow unvaccinated campers and staff at your camp. Understand the risk if you do accept a camper or staff member who has not been immunized for measles. ACA-Accreditation standards allow for a camp to accept campers who have not been immunized due to medical, religious or other reasons — requiring instead that the parent/custodial guardian can sign a waiver form. If someone not protected through immunization comes in contact with an infected person, many public health departments have initiated mandatory 21 day quarantine. Each public health department may handle this differently. For example, where the quarantine occurs (camp or elsewhere), who is quarantined including potential distinctions between people who have a medically documented reason for not being immunized (e.g. immune-compromised) versus those whose parents chose not to immunize, etc.
3. Understand the facts about the disease. Measles is a highly contagious disease caused by a virus. Measles can be serious — even fatal — for young children. While rare, it can lead to pneumonia, encephalitis (swelling of the brain), and death. People exposed to measles who have not been vaccinated almost always get measles.
4. Understand why there has been an outbreak in the United States. As of February 2015, 150 new cases of measles have been reported across 16 states in the United States. Public health officials have declared that the disease has spread in part because of lower rates of vaccination in certain parts of the U.S.
5. Ensure you have educated healthcare staff. While only a physician can diagnose measles, ensure that your healthcare staff understand the symptoms and have procedures in place to immediately seek medical care if measles are suspected.
6. Consider tracking the percent of immunized campers and staff at your camp. This may be important information for parents of children who cannot be immunized; it helps them understand the potential risk exposure for their child. Use data from last season if tracking this season’s percent is challenging.