Emerging Issues: Immunizations, Measles, and Other Communicable Diseases

April 2015
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.
 

IMMUNIZATIONS

Definitions

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.
 
Vaccines in the United States
 
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.
 
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. 
 
Examples: 
 
 

Immunization and Camps

ACA’s mandatory accreditation standard HW-5 addresses the issue of immunization:
HW 5.1: Does the camp require each camper to submit a current, signed health history that includes all of the following information in relation to the activities in which the camper may participate?

A. Description of any camp activities from which the camper should be exempted for health reasons;
B. Record of past medical treatment, if any;
C. Record of allergies and/or dietary restrictions;
D. A statement from the custodial parent/guardian attesting that all immunizations required for school are up to date and including the actual date (month/year) of last tetanus shot;
E. Record of current medications, both prescribed and over-the-counter; and
F. Description of any current physical, mental, or psychological conditional requiring medication, treatment, or special restrictions or considerations while at camp?

Furthermore, the “Contextual Education” for HW-5 further explains that: 
“If camps have minors who do not have immunizations, for religious or other reasons, a “record” can be a signed refusal or a signed waiver form.”
Camps should consult with legal counsel regarding the applicability of the school immunization laws to their business. Camps that include un-vaccinated individuals should require a signed exemption form. The form might include language such as:
 
“Because our camp program has a potential for communicable diseases, we recommend that program participants are appropriately immunized for, at minimum, the following diseases: tetanus, mumps, measles, rubella, polio, pertussis (whooping cough), and diphtheria. This being said, we recognize that some individuals may not be fully immunized for reasons that are biophysical (e.g., the individual is allergic to a serum component) or of personal choice (e.g., faith belief). This form is intended to capture information about individuals who are not fully immunized.”
 
A sample form is available to all ACA members.
 

MEASLES

Top Tips for Camps

 

  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. 
     
For more information about measles and camps, visit www.acacamps.org/resource-library/measles-information-camps
 

OTHER COMMUNICABLE DISEASES

While measles are rare, there are many other more common communicable diseases. The potential for the spread of communicable diseases at camp means that camps must continue to pay diligent attention to communicable disease control strategies.
 
Top Five Tips for Camps Regarding Communicable Diseases
 

 

  1. Partner with parents to reduce the introduction of communicable diseases in camp: Educate parents and caregivers about their role in illness prevention BEFORE camp begins. This parent flyer provides key messages for parents. 
  2. Establish “opening day” screening processes: Establish processes that screen campers for communicable diseases when they arrive at camp. Set a policy that states that the camp retains the right to refuse admission to someone who poses a communicable disease threat.
  3. Establish and implement policies that prevent the spread of disease: Personal protective practices such as frequent hand washing, remaining hydrated, sleeping with the greatest distance between heads, and effectively covering coughs and sneezes (with an arm or sleeve — NOT a hand) should be included.
  4. Establish policies to keep your staff healthy: Policies and performance evaluations should reinforce how important it is that staff take proper care of themselves, including getting sufficient amounts of rest. 
  5. Regularly evaluate and update your health care practices and procedures: Comply with standard HW-5. In addition, seek out and use the most-up-to-date information from trusted resources such as the Centers for Disease Control and Prevention (see Resources section below).
     

For more information and resources about camps and communicable disease, visit www.acacamps.org/resource-library/forms/health-forms-records.

Read the more from the 2015 Spring CampLine

 

RESOURCES

All American Camp Association Resources and Professional Development Offerings Regarding Communicable Diseases.  
American Camp Association. Sample Health Forms and Records. (Members only.)
 
States With Religious and Philosophical Exemptions From School Immunization Requirements: www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

Contributed by Susan E. Yoder

 
References
1. Retrieved from National Conference of State Legislatures. March 2015. www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx
 
2. Retrieved from National Conference of State Legislatures. March 2015. www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx