 member who chooses not to vaccinate, but I also don't want to cut this person out of our lives or make this an ultimatum, and say it's either us or them. Yes, this is an inconvenience, but it's an extra precaution that will give us peace of mind and we can go about our holiday. Hopefully in the next two weeks, these (measles infection) numbers will start to fall, but at least we'll know we're protected."
Taking firm stance on vaccines
Thinking about those vulnerable children — infants and children who are too sick to get vaccines, Hornik said, is what led him and the other doctors in his practice, Pediatric Care Corner, to decline to treat families who refuse to vaccinate their children according to the CDC's recommended schedule for philosophical or religious reasons.
"Our goal is not to kick people out of the practice," said Hornik, who is president-elect of the Michigan Chapter of the American Academy of Pediatrics. "Our goal is to take a firm stance on a lot of these families out there who are being wishy-washy and thinking let’s see what we can get away with, how long we can draw things out."
The policy went into effect nearly three years ago, he said.
"We had a patient pass away from complications from influenza," Hornik said. "And we had discussed it, and we thought to ourselves, this could have been completely preventable. The breaking point for us was that in my practice.
"There’s that small percentage of the population of people who you can talk to until the sun comes up, and you are not going to change their mind," he said. "I think it was more for the people that were hesitant. ... The hesitant people you can give facts and they can look at things logically and have an ongoing discussion.
"That’s really what we were trying to do. We are trying to have a thoughtful discussion, hear your needs, hear your concerns and then discuss those concerns and reassure them that things were going to be OK by sticking to the normal vaccine schedule."
The policy requires families to give their children all of the school-required vaccines, and strongly urges parents to consider also getting the flu shot each year as well as immunizations for hepatitis A and HPV (human papillomavirus).
"Since we have started this, we have only dismissed somewhere between 1% and 1.5% from our practice," Hornik said. "This is not like a massive number. This is a small number of patients who those were probably the people that I could give you 50 pages of facts, and it’s not going to change their minds. And unfortunately, those are the people who are part of the circumstance that’s going on right now."
The sick are vulnerable, too
Dr. Eric McGrath, an attending physician in the division of infectious diseases at Children’s Hospital of Michigan and an associate professor of pediatrics in the Wayne State University School of Medicine, said he thinks about the people who can’t get vaccinated because they are immune-compromised, such as those with autoimmune disorders, some patients with cancer or who are undergoing chemotherapy, those using high-dose oral systemic corticosteroids, patients with HIV and those who have received organ transplants.
"That’s what we’re the most worried about," he said. "Those patients are sitting out there in the community, and there’s nothing they can do in a sense, other than just sit in their homes, trying to avoid exposure, and that’s a sad life."
Because the incubation period for measles is so long — a person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days, according to the CDC — and people can be infectious while still asymptomatic, it makes it especially hard to avoid exposure.
"I had a question today from our cardiac transplant team about what to tell families about what they can do and what they can’t do. … It becomes this thing where — are they going to be doomed to sit in their homes until this abates? It’s difficult, though, because if you see the list of places where infected people have been 