Note from Linda Tate: This blog is a reprint by permission from one of our local DOs. We thank Dr. Cirino for this timely information.
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With all the talk about the recent measles outbreak in Clark County and now a confirmed case in Multnomah County, folks are getting into online disagreements about what measles can do and what they cannot do, and debating the worthiness of vaccines. We decided to go to the experts and ask some simple questions. What follows are the answers…please share this information so that others can benefit. To share, click the Facebook icon at the top of this blog. But first, grab A Cup of Coffee, and let’s chat!
At this point, many in Clark County Washington and adjacent Portland, Oregon are in a little bit of a scare. As of January 28th, there have been 35 confirmed cases and 11 suspected cases of measles in Clark County. In Portland, there has been 1 confirmed case of measles. This is likely going to be a moving target for the next several weeks. Measles was a disease that was essentially wiped out in the United States in the early 2000s. Since then, there have been outbreaks yearly from imported disease and unvaccinated children. The same goes with this outbreak.
Still in the world there are an estimated 7 million cases of measles yearly (2016 data), with the majority of deaths occurring in the developing countries. Places in Europe like Romania, Ukraine and Italy saw a 300% increase in measles cases in 2017. Last year, Ukraine had an estimated 54,000 cases of measles and the Phillipines saw 18,000 cases.
These cases are largely related to a breakdown in vaccination programs. Reasons include infrastructure, logistics and vaccine declination under the basis of fear of severe side effects (extremely low risk and largely fleeting), autism (debunked) and philosophical (get vaccinated). Measles is a vaccine-preventable disease.
With such few cases of measles in the US, it is likely that many physicians haven’t actually seen a case in the clinic. A heightened awareness is necessary. This is not equivalent to panic. Regarding the outbreak that has hit this region, I will go through 7 questions that may come to mind, now that this has all got our attention, and we already read something about the disease:
- Do I need to worry about measles if I have been vaccinated?
No – The vaccine is 97% effective after receiving the second dose (age 4-6y), unless you are in the unlucky 3% like me (I got the measles at age 15 traveling to see family in Italy). After the first dose (age 12-15 months) of vaccine, there is likely 93% effect. If you have not been vaccinated, it is not too late. Get vaccinated.
2. Do I need to worry about measles if my child is younger than 1?
Yes and No – Maternal antibodies are little gifts that mothers give their infants. If a mother was vaccinated or had the disease, the infant should have a robust passive immunity for 3-6 months after birth. The severity of a measles outbreak relates to the caseload and the herd immunity (goal >90% or more immune). For now in Portland (est. 87%), only having one case is low enough to make acquiring measles still extremely unlikely. In Clark county (est 78-80%), there is a little more concern, but this is still a disease in direct contacts only and almost all of the cases are unvaccinated.
3. How contagious is measles and does a mask help?
Very highly contagious. Yes. Measles can be transmitted on fine respiratory droplets (<5 micrometers) and are more densely packed on these than larger droplets (this is based on a study of influenza virus and masks in 2013). A person with measles becomes contagious 4 days before and 4 days after they develop the rash. Wearing a mask likely results in a three-fold reduction of transmission of virus — this means in short – that a mask over the mouth and nose is very useful. Any child that is presenting with the early findings of measles the 3 c’s– cough, conjunctivitis (red, itchy eyes) and coryza (runny nose) — should wear a mask and avoid social settings for now. Whether they actually will allow this is another thing. Contact your doctor for further instructions if you believe that someone you know may have the infection. The public health group or clinic will sometimes go as far as to take a sample in the parking lot to confirm this.
4. When does the rash appear and does everyone get it?
3-4 days after symptoms start. Yes. When you get the measles, expect to get a rash (exanthem). The rash usually starts initially inside the mouth (enathem) as Koplik’s spots. Next, the rash starts along the trunk and neck as sparse spots (maculae) and then becomes confluent in a generalized red, itchy rash.
5. Are there any treatments for measles?
No. There are no treatments available for measles other than a big dose of TLC (tender loving care, not THC) and a tincture of time. There have been some interesting studies performed on a similar virus model in animals – (science jargon alert) canine distemper virus (CDV). Ferrets given an oral RNA polymerase inhibitor after a lethal CDV dose (this is even a more severe disease as well in ferrets with 100% lethality) at time of viremia, recovered from infection.
6. What can I do to prevent getting the measles?
Get Vaccinated. This is an easy question. The majority of cases already reported in Clark County and the child in Portland were NOT VACCINATED. If you were concerned about the vaccination for your child, now would be a good time to get vaccinated. Although it would take about 2-4 weeks to confer maximal resistance, it would likely be protective against this outbreak and future ones to come. The risk of vaccination is mostly injection site related pain. It is a live, attenuated vaccination but not a risk if you have a normal immune system. Anyone with HIV, cancer, cirrhosis or on medications that impair the immune system, should not get vaccinated.
7. Will there be more outbreaks of this vaccine-preventable disease?
Sadly, Yes. This is a serious illness. Take it from me — At 15, I was in the tourist destination of Italy, yet couldn’t move more than the steps it took to get to the bathroom and back to bed for 8 days. There are still children mostly under 5 that die of this illness every year. In the US, the mortality rate is 1 in 1,000, the risk of encephalitis (infection swelling of the brain) is 1 in 1,000, but as many as 1 in 4 may need hospitalization. We have a world in which one can encircle it in 18 hours or less. As long as there are hot zones of measles in the world, any place in the US with a low herd immunity will get outbreaks. Especially in the Northwest.
“Vaccines save lives; fear endangers them. It’s a simple message that parents need to keep hearing.” Jeffrey Kluger
Thanks for reading! Dr. Cirino