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Friday Sep 04, 2015

Royal Pain: Team's Chickenpox Incident Offers Lesson for Patients

The Kansas City Royals have become a shining example of how to succeed in a small market in an era when baseball teams with the highest payrolls are often the biggest winners when it comes to the playoffs. After decades of futility, the reigning American League champions reversed their fortunes by pouring money into their scouting department and creating an elite team based on speed, defense and pitching.

Unfortunately, my hometown team recently became an example of what not to do, and it's a lesson family physicians can use when talking with patients and parents who have reservations about immunizations. After the Royals built a seemingly insurmountable lead in the American League's Central Division, a vaccine-preventable disease has done what few opponents have been able to do -- make this first-place team look vulnerable.

© Keith Allison
Kelvin Herrera of the Kansas City Royals delivers a pitch. Herrera and teammate Alex Rios were recently diagnosed with chicken pox.

According to The Kansas City Star(www.kansascity.com), the team's medical staff collects information from players about vaccinations and childhood illnesses every year during spring training. Apparently, that information wasn't reliable this time around, because in the thick of a pennant race, otherwise healthy young men have been sidelined by chickenpox, typically considered a childhood illness.

Kelvin Herrera is a 25-year-old All-Star pitcher who can throw a baseball 100 mph and is a key figure in the Royals' vaunted bullpen. Outfielder Alex Rios is a former All-Star and 12-year veteran. Both men are millionaires who have ready access to the team's medical staff and the means to afford excellent health care.

What they didn't have was immunity to the varicella-zoster virus. Now, Herrera and Rios are expected to miss about two weeks of playing time.

The incubation period for chickenpox can last up to three weeks, so it remains to be seen whether any more players will be affected. Sports teams can be a breeding ground for disease because athletes often spend time in tight quarters during games, in locker rooms and while traveling. It was less than a year ago that a mumps outbreak swept through the National Hockey League, affecting nearly two dozen players (including two-time MVP Sidney Crosby) from five teams, as well as two referees.

The take-home message for the general public is that if these strong, world-class athletes with access to quality health care, team doctors and excellent nutrition are susceptible to vaccine-preventable diseases, obviously, so is anyone else who has not been immunized, particularly children, the elderly and people with chronic conditions.

Patient registries and electronic health records can help us identify our patients who may be at risk. Those systems should be far more reliable than the Royals' method, which appears to have included asking athletes if they remember having chickenpox when they were toddlers.

In a study recently published(www.oxfordjournals.org) in the Journal of the Pediatric Infectious Diseases Society, CDC researchers compared national health care claims data from 1994 (the year before the varicella vaccine was introduced) to 2012 data and found that outpatient visits for chickenpox fell 84 percent and hospitalizations fell 93 percent. The recommendation for a second dose of the vaccine was introduced in 2007, leading to accelerated declines in the need for both inpatient and outpatient treatment.

Before the vaccine was introduced, about 4 million Americans got chickenpox each year, leading to roughly 11,000 hospitalizations and 100 to 150 deaths, according to the CDC. Despite the efficacy of vaccines, outbreaks of vaccine-preventable diseases continue because of inadequate coverage.

The United States had 23 measles outbreaks last year(www.cdc.gov), affecting more than 600 patients. This year, 188 cases in 24 states had been reported through Aug. 21, with the majority of illnesses stemming from the Disneyland outbreak that started in December.

In each of the past two years, more than 28,000 cases of pertussis(www.cdc.gov) have been reported in the United States. There were 48,277 reported illnesses and 20 pertussis-related deaths in 2012.

These sobering numbers should be shared with parents and patients who are resistant to immunizations. Sharing stories about famous athletes forced to sit at home because of the mumps or chickenpox couldn't hurt either.

Michael Munger, M.D., is a member of the AAFP Board of Directors who practices in Overland Park, Kan.

Posted at 01:30PM Sep 04, 2015 by Michael Munger, M.D.

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