Measles

Since immunization rates in many communities are down, the recent outbreak of measles that originated in Disneyland, CA is not going to be a rare event.

We’re getting more parents in to the ER with concern that their children have been infected with measles. Thankfully, I’ve not seen a positive case yet. Generally, it’s a rash of some other origin like hives, viral rash, or strep rash.

The best way to NOT get measles is to get immunized– plain and simple.

But, here’s some information straight from the Colorado Department of Public Health about measles infection.

Measles is highly contagious. It is a viral illness meaning that antibiotics aren’t going to cure it. We can only do symptomatic support. It causes fever and a distinct rash. The incubation period is 7-21 days. An incubation period means you are infected but are not yet showing signs of illness. Measles is spread via droplets (it can live on surface areas for up to two hours) and airborne via coughing or sneezing.

Early symptoms are fever (over 101.0 F), cough, runny nose and reddened eyes.

The rash usually begins on the face after 2-4 days of the above symptoms and then spreads from the head down and outward to the limbs. The rash is red, splotchy and raised meaning you can feel it if you brush your fingers over it.

Patients who present to the emergency department should be immediately isolated and placed in negative-pressure rooms if available. A negative-pressure room sucks air into it versus pushing air out into the rest of the department. Also, the room should be cleaned and then quarantined for two hours after the patient is discharged or admitted.

Only healthcare workers who have measles immunity should care for these children.

People at risk for severe illness and complications from measles are infants less than 12 months, pregnant women who don’t have measles immunity, and those who are immunocompromised.

Go here to learn more about measles infection.

How many of you have heard the name Dr. Andrew Wakefield? His uber-small, sample study that linked childhood vaccines to autism was retracted by the British Medical Journal. Why is this important? This study fueled the fire for many people choosing not to immunize. But really, what harm is it not to immunize your child against common childhood diseases? You can read about this retraction and the impact it has by following this link: http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html

I want to introduce a concept to you. It’s called herd immunity. I can already see index fingers flying up, scratching a few temples. Cows? She’s talking about cows? This girl has lost her mind– been working too many 12 hour shifts.

Malibu56/Photobucket

Let me explain. Herd immunity is the number of immunized individuals in a group (be it people or cows). It affords certain protection if the “herd” is largely immunized. Let me paint a scenario for you. Take a population of 100 people. Now, 99 of them are immunized against measles. There is a measles outbreak in the next town five miles over. Measles is highly contagious. What’s the chance of measles taking hold in this community where 99% of individuals are immunized? What if the herd immunity in that town was 80%. What are the chances then?

In this scenario, the likelihood of measles taking hold in the community where 99% of people are immunized is low. Dr. Paul Offitt, in his book, Deadly Choices, states that likely 95% herd immunity will protect a community against measles. In 2008, the following states all had immunization rates <70%: Washington, Vermont, Idaho, Montana and Nevada. The likelihood of a measles outbreak taking hold in those state is high.
In the article above concerning Dr. Wakefield, it lists some of the ramifications of people choosing not to immunize.

“The now-discredited paper panicked many parents and led to a sharp drop in the number of children getting the vaccine that prevents measles, mumps and rubella. Vaccination rates dropped sharply in Britain after its publication, falling as low as 80% by 2004. Measles cases have gone up sharply in the ensuing years.”

The 95% herd immunity for measles seems to hold true.

“In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention. More than 90% of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported.”

But really, what’s the problem with a case of measles? Why did they invent that vaccine anyway? You can read more about measles infection on the following links but one possible complication of measles infection is encephalitis (1:1000 measles cases). I was a little shocked by that number. Encephalitis is an infection in the brain.

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002536
2. http://kidshealth.org/parent/infections/lung/measles.html

The main concern with measles is that it is highly contagious. There is no “cure” once a case is contracted, merely symptomatic support. Measles is very concerning if a pregnant woman contracts it. Read the following:

“If you’re not immune to rubella and you come down with this illness during early pregnancy, it could be devastating for your baby. You could have a miscarriage or your baby could end up with multiple birth defects and developmental problems. Congenital rubella syndrome, or CRS, is the name given to the pattern of problems caused when a baby is born with the virus.”

I think the following paragraph lends support to the point of having high herd immunity when it come to measles.

“Rubella has become quite rare in the United States, thanks to a very successful vaccination program. Before the rubella vaccine was developed in 1969, a rubella epidemic in 1964 and 1965 caused 12.5 million cases of the disease and 20,000 cases of CRS in the United States. In contrast, between 2001 and 2005, there were a total of 68 reported cases of rubella and five reported cases of CRS. And in 2006, there were just 11 reported cases of rubella and only one case of CRS.”

Here is the link for these quotes: http://www.babycenter.com/0_rubella-german-measles-during-pregnancy_9527.bc.

How often do you hear this side when it comes to the immunization debate? What good is this for fiction? I talked to a pediatrician in our area and asked him what his current rates of immunization were. He stated he was lucky to have 50% of his kids immunized. Some of those children are now women of childbearing age. I think it would be easy to add as a pregnancy complication for any story. What about a measles outbreak?

What do you think?