UPDATE: The CDC later disproved the one measles case in Alabama. As of June 18, 2019, more than 1,000 measles cases have been confirmed in the U.S., but no confirmed cases have reached Alabama.
The CDC (Centers for Disease Control and Prevention) has reported over 700 cases of measles in 22 states from January 1 through April 26, 2019, and now Alabama has been added to this growing list. A five-month-old infant from St. Clair County was confirmed to have measles just this past week.
These outbreaks are occurring due to unimmunized travelers bringing measles from other countries that are currently experiencing large measles outbreaks due to inadequate vaccination programs. International travelers need to get vaccinated against measles before leaving the U.S.
Most of the 700-plus people in the U.S. who were infected with measles were unvaccinated. This virus spreads quickly in communities where groups of the population are not vaccinated. The best way to avoid infection with this highly contagious disease is prevention through vaccination.
Measles is a virus that causes an acute respiratory infection that starts with high fever (up to 105 degrees F), malaise, the three “C”s: cough, coryza (cold symptoms), and conjunctivitis, small white spots inside the mouth, followed by a rash that starts on the face and spreads to the rest of the body. Contagiousness is described by the four “D”s: infected persons are considered contagious from four days before until four days after the rash appears. It may take up to 14 days for a person who was exposed to measles virus to develop the rash.
Measles is one of the most contagious diseases today. Nine out of 10 unvaccinated persons exposed to measles will become infected. (By comparison, only two out of 10 persons exposed to the deadly Ebola virus will become infected). The reason for measles virus having such a high rate of infectivity is that it is transmitted through direct contact with infectious secretions, and by airborne droplets from an infected person’s cough or sneeze, which can live in the air for up to two hours. This means that a person does not have to be in direct contact with an infected person to be exposed.
The complications from measles may include ear infections, pneumonia, croup-like illness, and diarrhea. One out of 1,000 cases will develop encephalitis, which can cause brain damage. One or two out of 1000 cases will die from respiratory and neurological conditions. A rare, though fatal condition, subacute sclerosing panencephalitis (causing brain damage, behavioral changes and seizures} may develop a decade after measles infection.
Those persons at highest risk for severe illness from measles are children under age five, especially those under 12 months, adults over age 20, pregnant women, and persons with a weakened immune system, such as those with immune deficiencies, and those undergoing some treatments for cancer.
There is no anti-viral treatment for measles infection. Care is supportive to help relieve symptoms, and to treat any secondary bacterial infection. Prevention with vaccination (MMR) is the best defense. One dose is approximately 93% effective at preventing measles, and two doses are approximately 97% effective. The small percentage of persons infected, despite being properly immunized, are much less likely to suffer measles complications, and are less contagious to others.
Current CDC recommendations are that children receive their first dose of MMR vaccine at 12 –15 months of age, and the second dose at 4-6 years of age. Students entering college without evidence of immunity will need two doses of MMR vaccine, at least 28 days apart. Adults born during or after 1957 without evidence of immunity should get at least one dose of MMR vaccine. Persons born before 1957 are considered immune, as they are likely to have been infected naturally and are presumed to be protected.
International travelers aged six months and older should receive MMR vaccine. Infants 6 –11 months of age should receive one dose of vaccine early. Infants who get one dose of MMR before their first birthday should still receive two more doses. Children 12 months of age and older should receive two doses of MMR, at least 28 days apart. Adolescents and adults who do not have evidence of immunity against measles should get two doses of MMR, at least 28 days apart.
Healthcare workers that do not have evidence of immunity to measles should receive two doses of MMR, separated by at least 28 days.
There are a few exceptions to the above recommendations for MMR vaccination. You should not receive this vaccine if you have had an allergic reaction to a prior dose of MMR, or if you are allergic to neomycin, or if you have been advised not to receive this vaccine by your doctor. Since MMR is a live-attenuated vaccine, you should not receive it if you are severely immunocompromised, or if you are pregnant.
Serious MMR vaccine complications are rare. Some more common side effects are soreness or redness at the site of injection, mild fever, and a rash. In the past, false claims have been made of a connection between MMR vaccine and autism. Extensive scientific studies have since proven conclusively that NO such association exists.
In the U.S. most physicians practicing today have NEVER seen a single case of measles. The reason is due to our extensive childhood immunization practices in which we eradicated this disease from our population almost 20 years ago. That protection is being diminished every time someone decides not to vaccinate their child.
Measles resurgence is happening now. Be proactive. Check your immunization status. If you are not sure that you, or a family member is protected, ask your doctor.
Let me help you protect your children, our most precious resource!
Patricia Harris, M.D.
HealthyKids of Gardendale, P.C.