Five workers at Disneyland have been diagnosed with measles in an outbreak that California officials trace to visitors at the Anaheim (Calif.) theme park in mid-December. Disney is urging its 27,000 workers at the park to verify that they're inoculated against the virus, and the company is offering tests and shots on site for workers who are unvaccinated. "We’re doing everything that we possibly can to proactively communicate to our cast members," said Disney spokesperson Lisa Haines.
Disney won't, however, require workers to get routine vaccinations as a condition of employment. Almost no companies outside the health-care industry do. "Our policies are consistent with other employers' policies on this issue," said Haines, noting that airports, hotels, and other businesses whose staffs encounter lots of potentially contagious travelers don't mandate immunization. She declined to say how many Disney workers have been inoculated since the outbreak. Three of the workers who caught measles have recovered and returned to work.
Most employers concerned about the spread of communicable disease in the workplace do exactly what Disneyland is doing now: They strongly encourage, but don't require, immunizations. "To make things mandatory just raises a lot of legal concerns and legal issues," said Rob Niccolini, co-chairman of the health-care practice group at employment law firm Ogletree Deakins.
Even asking about workers' vaccination status can be thorny. Employers are barred from discriminating on the basis of medical status (under the Americans with Disabilities Act) or religion (under the Civil Rights Act), and questions about immunizations could reveal both. Some people can't get vaccinations because they're allergic, immunocompromised, or have other medical conditions. Others forgo shots on religious grounds. "Outside the direct patient-care context, requesting that sort of information can be problematic for most employers," Niccolini said.
It's a different story for health-care companies, whose unvaccinated employees could put patients at risk. Some states require hospital staff to get inoculated against diseases such as measles or to get seasonal influenza vaccines. Some individual hospitals institute such policies on their own. The first hospital to require workers to get flu shots was Virginia Mason in Seattle in 2005. The mandate increased the proportion of staff inoculated from 54 percent to 98 percent, though the nurses' union successfully challenged the policy because it was instituted outside of the collective bargaining agreement. More than 300 medical facilities have followed suit, according to L.J. Tan, chief strategy officer of the Immunization Action Coalition, which works with the CDC to promote immunizations. People who can't get vaccinated for medical or religious reasons are usually allowed to forgo shots if they wear a mask during flu season.
Most employers considering vaccination programs focus on flu because they recognize the cost of sick employees to their business. While a measles outbreak is a publicity nightmare for Disney, the disease affects few Americans because most kids get vaccinated before starting school. The vaccine is 99 percent effective, and widespread coverage eradicated measles as an endemic disease in the U.S. in 2000. New cases since then have been introduced by travelers from parts of the world where measles remains widespread. But pockets of Americans who don't vaccinate—many driven by discredited research on the risks of vaccines—have enabled imported cases to spread. That has led to resurgent measles outbreaks in America, with far more cases last year than in any year since 2000.
Source: CDC California officials have identified 59 confirmed cases in the current measles outbreak, including 17 that haven't been connected to Disneyland. Of the patients for whom officials could verify vaccination status, 82 percent hadn't gotten their shots, primarily because they intentionally declined, according to Gilberto Chávez, deputy director of the state's center for infectious diseases, who briefed reporters on Wednesday, Jan. 22. A quarter of those infected have been hospitalized. Another eight cases of measles outside California, including one in Mexico, have been linked to the Disney park. Other cases likely haven't been reported. "We can expect many more cases of this vaccine-preventable disease unless people take precautionary measures," Chávez said.
As part of their case investigations, California officials attempt to trace all contacts for measles patients and check whether people they've come into contact with have been vaccinated. Because people can be sick for several days before the tell-tale rash indicating measles appears, that often means they've been to the doctor, sometimes several times. California laws require that health-care workers be checked for immunizations, said Kathleen Harriman, the state's chief of preventable diseases. "Most hospitals do a really great job of that with all new employees," she says. "That’s not always the case with smaller clinics."
Chávez said Disney has been working with public health officials, and he's talked to the company about their plans to identify workers who might be vulnerable. "They recognized that they were just a meeting place for measles," he said. "And they are quite concerned about doing what they can to help control the outbreak."
