MEASLES

What are measles?

Measles, also known as rubeola, is caused by a virus. It is an infectious disease that causes a red rash across the skin, fever, and with no cure, it can lead to permanent brain damage and/or death.

Prior to the measles vaccine, over 2 million people around the world died every year and in America, there were 3-4 million people, mostly children, who contracted measles every year. Americans also averaged around 400-500 deaths prior to the vaccine, with around 1000 children suffering permanent brain damage every year. After 1963, when the vaccine was introduced, the infection rate amongst children dropped to just 37 cases by 2004, all from people who were from other countries. Unfortunately, 10 years later in 2014, that number rose to 667. Scariest of all, as of the first 3.5 months of 2019, there have already been around 555 confirmed cases in the US and we are on pace to see almost 2000 cases this year. Although death rates may be low in America, thanks to our high-quality health care system, complications are still possible and can lead to serious lifelong brain damage. Currently, measles are one of the top causes of death in children under the age of 5 in the world, with about 90,000+ children dying a year.

What are the symptoms of measles?

1. It can take up to 2 weeks after being exposed to the measles to develop the first symptoms.
2. Runny nose, cough, and red eyes first appear and can look like the common cold or allergies for about 2-8 days before the rash appears. Other symptoms include a low-grade temperature, body aches, and a slight upset stomach.
3. White spots called Koplik spots develop on the inside of the cheeks 2 days prior to the rash and can last 12-72 hours. Click on "Koplik spots" to see a picture from the CDC.
4. 2-8 days after the upper respiratory symptoms start, the typical measles rash starts. The rash is red and starts at the hairline and over the next few days will cover the body and spread all the way down to the feet. This coincides with the fever, which can be quite high, sometimes as high as 105. The rash lasts about 3-4 days and starts to fade from top to bottom just like it appeared.

What is the measles vaccine?

The measles vaccine was developed in 1963 by scientists in the US. Although a weakened version, the measles vaccine is a live virus, which means it shouldn’t be given to those with weakened immune systems or those that are in very close contact with people who may be immunocompromised. It is given as a live virus because it builds a stronger immune response than a killed virus. It is almost always given with the mumps and rubella vaccines hence the name, M-M-R (Measles-Mumps-Rubella). The vaccine is typically given for the first time at 12 months of age and again at age 4 or 5. If the first MMR vaccine is given after age 4, the 2^nd dose can be given 29 days later.

How is measles diagnosed?

Measles is usually diagnosed by history and physical exam.  However, it can also be diagnosed and confirmed by testing the secretions from the nose or drawing blood.

Why is Measles so contagious?

1. You are contagious 1-5 days before the first upper respiratory symptoms start.
2. Once you get sick, it looks like a common cold or allergies with a cough, runny nose, and red eyes.
3. When someone with the measles coughs, the virus can stay airborne for up to 2 hours exposing even more people.
4. Even after the rash and fever disappears, someone with the measles is still contagious for another 4 days.

 What complications can come from measles?

Diarrhea is the most common complication followed by ear infections.  Pneumonia is also a complication and is responsible for 85% of deaths especially in developing countries. Pneumonia usually sets in a few days after the rash appears. 

Next to death, a frightening complication is called encephalitis. Encephalitis is inflammation and infection of the brain.  There is no cure and will more than likely lead to either death or permanent brain damage. 1 in 1000 people develop this unfortunate complication due to measles. The symptoms of encephalitis includes fever, headache, vomiting, seizures, and coma. It usually occurs 5 days after the start of the rash. 

What is the treatment for measles?

There is no treatment for measles, just symptomatic care such giving fever reducers and medications for the cough and congestion.  As mentioned above, you do have to watch for bacterial infections such as pneumonia or ear infections. If your child is unvaccinated and they have had confirmed exposure to someone with the measles, you should contact their physician.

What can I do if there is a local outbreak?

Typically, as long as your child has one or both vaccines, there is nothing to worry about.  If you or your child haven’t been vaccinated, get the MMR vaccine ASAP.  Immunity can be built up in about 72 hours after the first dose and a 2^nd dose can be given after 29 days for full immunity.  However, if you are insistent on not vaccinating yourself or child, avoiding public areas is important. As stated above, 1 in 1000 child end up with permanent brain damage and you shouldn’t be willing to roll the dice with your child during an active outbreak.

Who should not get the measles vaccine?

Those who are pregnant, allergic to neomycin, or have been on high dose steroids shouldn’t get the vaccine.  I would recommend getting vaccinated if you are thinking about becoming pregnant so the antibodies can be transferred to your baby. 

My thoughts:

I’ve been asked by quite a few people about the measles outbreak and my thoughts about those who don’t vaccinate. Unlike a growing number of pediatricians, I choose to continue to take care of unvaccinated children and will always do so. That being said, I do find it interesting that the parents who choose not to vaccinate their children all come from families whose parents vaccinated them and their siblings with absolutely no complications.  My older patients who grew up in the pre-vaccine era are appalled by the risks that parents are willing to take with their children. They remember polio destroying the lives of their classmates who left the school year exceptional athletes and began the next school year paralyzed or dead.  Older pediatricians can remember prior to the Prevnar (Streptococcal Pneumoniae vaccine) and HiB (Hemophilus Influenzae) vaccines high rates of bacterial meningitis that could kill within 24 hours or leave permanent brain damage. As the baby boomers die off and can no longer tell the horrific stories of lives lost or destroyed by diseases for which there is now protection from, my fear is that the FULLY vaccinated adults who put debunked and flat out false information on the internet as a sick joke will become louder. As my patients have heard me say, you will always find what you are looking for on the internet.  The 2-4 week period of work a parent has to miss to nurse a sick child with measles can wreck financial havoc on a family because who the heck would want to watch their kid!!!!!! I shouldn’t say this but luckily my community has a high, >95% vaccination rate meaning herd immunity will largely protect those who aren’t vaccinated. I am in no way stating that those who do not vaccinate are bad parents in the least bit as silly pediatricians online would like to suggest. However, if you come from a family that was vaccinated and everyone turned out fine, why not vaccinate your children? Don’t risk your child’s life.