Measles - how you can protect your child, yourself, your community!

1/28/15

In a worrisome group of cases that public health officials are rushing to contain, at least 85 people in six states and Mexico have fallen ill from measles since mid-December, most of them from here in California. The vast majority of those who got sick had not gotten the measles-mumps-rubella, or MMR, vaccine.

Of the confirmed cases, over 40 have been linked to Disneyland or Disney California Adventure Park in Anaheim, California. The confirmed cases include five Disney employees - four of who worked at the parks and one who is believed to have been infected as a guest. Initial exposures occurred in December but additional confirmed cases visited Disney parks while infectious in January.

Disneyland attracts millions of visitors each year from not only all over the United States, but also from all over the world. It’s theorized that the outbreak at Disneyland was as a result of an unvaccinated contagious visitor.  Vaccination has made Measles rare in the US, but NOT worldwide, as many countries abroad do not require the vaccine, and even here in the US, a growing movement to decline vaccination places our children and adults at greater risk.

What is measles? What does it look like?

Measles is a highly contagious disease that causes fever and rash. At first, measles (also known as Rubeola) looks and feels like a cold. Cough, high fever, runny nose, and red, watery eyes are common. White spots then show up inside the mouth (Koplick spots are diagnostic of measles). A few days later, a red, blotchy rash starts on the face, then spreads to the rest of the body, even covering the palms and soles of the feet.

Measles can lead to ear infection, pneumonia, seizures (jerking and staring), brain damage, and death. Especially vulnerable are children under 6 months, pregnant women, and those with chronic illnesses or immune compromise.

How is it spread?

Through coughing, talking and sneezing. The virus can stay alive and infectious for up to 2 hours. That means a person with measles can leave the room, and up to 2 hours later, if you walk in, you have a 90% chance of catching it!

What is the incubation and how long is a person contagious?

A person is contagious 4 days before the onset of symptoms, and for 4 days after the appearance of the rash. The average time from exposure to illness is 10-12 days – but disease can occur as soon as 7 days and up to 21 days after exposure. Special care must be taken to avoid contact with unimmunized babies and pregnant women.

Who is at risk for getting measles?

•                Anyone who never had measles and has never been vaccinated

•                Babies younger than 12 months old, because they are too young to be vaccinated

•                Those who were vaccinated before 1968; early vaccines did not give lasting protection

Is there treatment for measles?

No – only supportive care (IV fluids, oxygen and ICU care for those with complicated cases)

Why immunize?

Measles is one of THE most contagious viral diseases out there – a susceptible individual has a 90% chance of contracting the measles if exposed and approximately 25% of those with measles require hospitalization.

When should we vaccinate?

All healthy children should receive a first dose of MMR at 1 year, and again at KG entry (between 4-6 years of age).  Infants between 6-11 months travelling internationally should have 1 dose of vaccine at least 2 weeks before travel, and again at 1 and 5 years of age. If unimmunized, older and catching up, 2 doses are given, at least a month apart. If you are an adult and had one dose after 1968, a second dose is required if you are in health care, travelling internationally, exposed to measles, or if lab tests show you are not immune.

What are the risks of the vaccine?

Low grade fever a day or 2 after the vaccine is typical and a small% of kids may develop rash and gland swelling a week or 2 after the shot.

1/3000 children with fever may have a “febrile” seizure , and 1/30000 may develop temporary low platelet counts.  Less than one in a  million develop allergy to a component of the vaccine.

If others vaccinate, aren’t I protected from the herd?

When it comes to measles, the answer is “no.” Because at least 93-94% of the population has to be effectively immunized for herd immunity against measles, vaccination of all who are able/eligible is key. If a child or adult receives the MMR vaccine, with appropriate booster doses, there is a 99% chance of being protected.

However, there are a small % of folks who can’t get the vaccine (immunocompromised or allergic to a component of the vaccine) or who simply don’t generate immunity after receiving it, or are under the age of 12 months (too young) and so the successful vaccination of the remainder of a society is key to protect those susceptible few.

History of Measles in the US:

Before the vaccine, the U.S. experienced approximately 3 to 4 million cases a year with approximately 500 annual deaths. In the 80’s, several outbreaks occurred in college campuses and sports arenas – thus changing the requirements for college entry to include vaccination. The 1991 measles outbreak in Philadelphia claimed 9 lives amongst the 1400 cases – the ratio of case fatalities was 1.2% even with modern medicine/supportive care available.

With the advent of the measles vaccine in 1960 there was a marked reduction in cases and in 2000 Measles was declared “eliminated” from the US – so although now not endemic, the virus does sporadically appear within the US – and with the advent of the anti-vaccine movement, more and more cases have been described – especially over the last 3-4 years.

The original “study” linking measles and autism has been completely refuted, and several long term well controlled studies have disconnected this link, for good.  That being said, the notion that MMR is linked to autism still lives. A couple of years ago outbreaks in Manhattan forced public schools to exclude students who were unimmunized if they had a family member with measles – a case that went to court. Several private schools in affluent areas of California and Washington state have vaccine rates that are as low as the Sudan – because parents can sign an exemption from vaccination by law.

What is happening currently to control the outbreak?

Disney employees who have been immunized are allowed to work, and those whose immunity is still in question are on paid leave until their lab results are back.

People with children under a year of age are discouraged from attending the park.  Unimmunized individuals, while not officially excluded from the park, are being asked to hold off on visiting as they are very susceptible to contracting the disease.

Unimmunized adolescents in Huntington Beach have been sent home for 3 weeks because of one case in their school, and the great liklihood that an epidemic will grow if they are not removed from their classmates.

Standing back, the other picture here is one of benevolence…over 7000 children visit Disneyland and more go to other theme parks as a “Make a Wish Foundation” request…these are children highly susceptible to illness, whose last wishes include a visit to the happiest place on earth.  By not immunizing we are placing those children at huge risk, as well as our own, and any baby under 1 year of age…whether at a park, in the doctors’ office, or in a public place….is a stubborn belief in archaic refuted non-science worth that for the population as a whole????

For video of this segment go to: http://youtu.be/nxTyipugl6w