HCN News & Notes

Baystate Physician Explains Current Measles Threat and Prevention

SPRINGFIELD — When it comes to the measles, the recent news isn’t good.

Thanks to a vaccine which became available in the 1960s, the disease was virtually eliminated in the U.S. in 2000. Now things are different. According to the Centers for Disease Control and Prevention (CDC), 349 cases of measles were confirmed across 26 states and the District of Columbia in 2018.

“When it comes to measles, you must vaccinate,” said Dr. J. Michael Klatte, a pediatric infectious diseases specialist at Baystate Children’s Hospital.

Washington state recently declared a state public-health emergency after nearly three dozen cases were confirmed there recently. Nearly all of the confirmed cases so far have occurred in an area of southwest Washington that borders Portland, Ore. All except one of those people infected are either children or teenagers, and 30 are known to be unimmunized. Another large outbreak of measles is currently ongoing in certain portions of New York City, with more than 60 cases diagnosed since October 2018. Those cases have been traced back to an unimmunized traveler visiting a country that is currently experiencing a large outbreak. Most of the cases in New York City have also occurred in children who have not been immunized.

“Children and adults in our local community who have been appropriately vaccinated should have nothing to fear as far as these current outbreaks are concerned,” Klatte said. He added, however, that “measles is one of the most contagious of all infectious diseases. The measles virus can live for up to two hours on surfaces or in the air where an infected person has coughed or sneezed.”

Also, according to the CDC, measles is spread so easily between people that 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those without immunity will become infected simply by being near someone who has the virus. 

“Once again, the current outbreaks in Washington state and New York bring attention to those who are hesitant to have their child vaccinated, not just for measles, but for any disease. And, what we do know about the current outbreak is that the majority of cases are people who were not immunized for measles, including both children and adults,” Klatte said.

He explained that the measles vaccine is one of the oldest and safest vaccines available today. It is 93{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} effective in preventing measles infection for those who receive one dose, and 97{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} effective for those who have gotten two doses. Severe reactions are extremely rare, while mild side effects from the shot can include fever, mild rash, and swelling of glands in the cheeks or neck.

Symptoms of measles occur 10 days to two weeks after exposure, and may initially resemble other viral respiratory infections (with fever, cough, runny nose, and red eyes). A rash occurs, however, on the skin about two to four days after the initial symptoms develop. The rash appears first on the head and then moves downward. It gradually disappears in the same pattern in which it appeared, and lasts about six days before completely disappearing. People with measles are contagious from four days before the rash appears until four days after the rash’s onset.

“There are no antiviral drugs to stop the measles virus once a person is infected. Unfortunately, all that we can do is to treat the resulting symptoms, such as fever control with acetaminophen. We also recommend that parents keep their children hydrated, and that they get plenty of rest,” said Klatte, who noted that symptoms in those without complications are likely to persist for approximately seven to 10 days.

Children under age 5, adults older than 20, pregnant women, and people with compromised immune systems are at highest risk for development of measles complications. Common complications include ear infections, croup, and diarrhea, while more serious ones can include pneumonia (occurring in 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those infected) and brain swelling/neurologic damage (occurring in 1 per 1,000 cases). According to the CDC, for every 1,000 children who get measles, one or two will die from it.

People who were born before 1957, have had a documented case of measles in the past, or who have been vaccinated against measles per the Centers for Disease Control recommendations are considered immune.

According to the CDC, children should receive their first dose of measles-mumps-rubella (MMR) vaccine at 12 to 15 months. School-aged children need two doses (with the second dose occurring between 4 and 6 years old). Adults should have at least one dose of MMR vaccine. Certain groups at increased risk for infection need two doses of MMR vaccine, such as international travelers, healthcare workers, and college students.