Measles Resurgence: Reason for Worry or Media Hype?
Measles used to be ubiquitous - a merit badge of childhood illness among the other scourges of mumps, chicken pox, influenza and the common cold. Doctors were well-versed in identifying the telltale spots in the mouth that confirmed the diagnosis. With the advent of the measles vaccine though, the virus seemed a thing of the past. Doctors had written-off measles as it was declared all but extinct in America, and only a small minority of today's practicing doctors have seen a single case.
Now though, measles are headline news as the media reports on pockets of spread and fuels fear among Americans. But should we carry bona fide worry about the resurgence of measles or is this simply hype in the vax/anti-vax battle? How contagious or harmful is the measles virus and how is it treated?
Measles are caused by a virus, and as viruses go, it is actually a pretty simple one. There is only one type of the virus and humans are its only host.
The thing that distinguishes measles from other illnesses though, is that it is extremely contagious. If a person is susceptible to measles and has come into contact with someone infected, there is a 90% chance they will get the illness. The virus is spread via respiratory droplets that are expressed when the infected coughs, sneezes or even breathes and can remain infectious in the air or on surfaces for a full two hours. This creates a huge problem in crowded situations like schools, sporting events, doctors offices, emergency rooms or the recent example of Disney Land.
The incubation time (time between exposure and illness) for measles is 7-21 days. Things usually start off with a fever and then fatigue and a cough. The full syndrome involves what has long been known as “the three C’s:” cough, conjunctivitis and coryza. Coryza is inflammation and mucous discharge of the membranes of the respiratory tract such as the nose and throat. They eyes can also be involved producing matter. Most characteristic of measles though, is the progression of Koplic spots to a red rash. Koplic spots are clusters of white spots on the membranes of the cheeks. They have been described as looking like grains of salt on a wet background. The rash consists of broad red spots that starts on the head, spreading downward to the trunk and then the legs.
Most cases of measles will resolve on their own without serious complication. Before vaccination when measles was common, there were typically about 500-600 deaths in America annually from the illness. (Compare this with the NIH's low estimate of influenza deaths - 3,000 a year.)
The most feared complications are respiratory deterioration to pneumonia and encephalitis, a neurologic condition. About 1 in 1000 cases of measles will develop acute encephalitis which often leads to permanent brain damage. A more rare progressive encephalitis called subacute sclerosing panencephalitis (SSPE) is a slow degeneration of the nervous system that leads to behavior changes, seizures and eventually death.
Measles virus is prevented through vaccination. This has been routine since 1963. The vaccine is a live attenuated vaccine. This means that it is a living strain of the virus that has been disarmed. It is rather like a tiger with no teeth or claws - still a tiger, but not harmful. The vaccine provides just enough of an exposure to measles for the body to develop immunity to the illness. The vaccine is first given at 12-15 months for optimal response. A booster is needed at 4-6 years of age. The first dose is 93% effective in generating immunity, the booster increases this rate to 97%. The measles vaccine is combined with mumps and rubella (MMR).
This vaccine does not cause autism, a myth that has been thoroughly debunked.
Because measles is much more prevalent in countries where vaccination is not as universal, the CDC recommends that the MMR vaccine be administered early for international child travelers. For infants at 6-12 months of age, a first vaccine is recommended to at least get some immunity. If one dose has been given, a booster should be given if at least 28 days have transpired from the first dose. If early doses are given, they must also be given at the recommended age ranges.
Are YOU protected?
Persons born before 1957 are presumptively immune. Documentation of two vaccines given at the proper times are also adequate. It is wise for healthcare providers to have laboratory documentation of immunity. When immunity is uncertain, two courses of action are acceptable. Immunization can just be given or a laboratory testing for immunity can be performed. Documentation of vaccination is presently entered into a computer data base for healthcare and educational institutions to access. In older days, a record was kept on a card in the possession of parents. Documentation was also placed in the chart of the family doctor, pediatrician or health department.
Why Measles are Coming Back
In 2000, measles was declared beaten in the U.S. Extremely rare cases seen were imported from infected individuals travelling from other countries. Over recent years, forgone vaccinations in children due to parents wishes have relied on the concept of “herd immunity,” or protection from vaccinated contacts. As the numbers of unvaccinated children increased, however, susceptibility developed. Thus, when a rare imported case hit Disney Land in a crowded area with a substantial enough numbers of unvaccinated children, an epidemic ensued. With the extreme contagion of measles, spread was inevitable. As a healthcare provider in the trenches, I would be hard pressed to deny a request from a parent to vaccinate their child early for their child without upcoming international travel if heading into an area where measles has been documented domestically.