Let's all learn something about measles today...
Measles… measles… measles. The subject is everywhere in the media right now, and as a result of the outbreak that appears to have started in Disneyland. This has brought up many conversations with my patients lately; especially with my patients who have chosen not to vaccinate their children. Everyone is trying to figure out what is best for their family during this outbreak. I think it is important to take a step back, learn about measles, and also to learn how it has affected the U.S. in the past year. According to the CDC website, there were 644 cases of measles in 2014 in 27 different states, and as of the 28th of January, 2015, there have been 84 cases of measles this year. The CDC’s website says they update their numbers on Mondays.
What is Measles? - Most of us know it as a childhood disease. Depending on when we were born, for some of us this was a natural disease that we had, and for others they were vaccinated against it in their childhood. It is not uncommon for me to see patients who had measles as a child; especially within my patient population over the age of 50. Measles is caused by an enveloped, single strand RNA virus which naturally only has humans as a host. Before the vaccine, more than 50% of people had measles by the age of 6 with more than 90% by the age of 15. Prior to 1963, 3 to 4 million people would have measles per year with an average of 450 deaths.
Transmission - Measles is transmitted through the respiratory tract via droplets that enter into the nasal passageway. There is no fomite transmission (inanimate objects such as door handles, money, etc) in the case of measles.
Signs, and Symptoms - Prodromal fever that can reach as high as 105 degrees can usually lasts for 3 to 4 days. Also, the “3 Cs” meaning conjunctivitis, coryza (runny nose), and cough which is then followed by Koplick spots. Koplick spots is a rash that appears in the mouth, and usually in the mucous membranes of the cheek. They are usually tiny white dots on a reddish bump, and can last around 1 to 2 days. The measles rash is a red, and blotchy that appears 3 to 7 days after the prodromal symptoms. The rash will begin on the face then becomes generalized lasting 4 to 7 days.
Immune System - One of the complications with measles is how it attacks the immune system. Since it causes great immunosuppression, there is risk for secondary infections which lead to most of the complications associated with measles. These common complications can be diarrhea (8%), otitis media (7 to 9%), pneumonia (1 to 6%), and a rare complication of encephalitis which affects 1 in 1500. The population that is at greatest risk includes the young, children and infants, adults, and also patients that are already immunocompromised.
The Measles Vaccine - The measles vaccination has a history all to itself. It was first isolated from the throat of a 13 year old boy named David Edmonston, in 1954. The vaccine started off as an inactivated measles vaccine, but that had to be discontinued as many people got atypical measles infection. The vaccinated children developed an especially vicious form of measles due to the altered immune response of the host. The formeched strain was licensed in the U.S. in 1963, and used until 1967. In 1968 a further attenuated strain was made by Merck (Attenuvax) that had fewer side effects than the other attenuated form of the Edmonston B Strain.
In 2008 Merck discontinued the Attenuvax in favor of an MMR II combination. The MMR II combines three live vaccines - Attenuvax (measles), mumpsvax (mumps), and meruvax (rubella). Thus we are no longer able to get the measles vaccine alone as we had in the past. This combination vaccine does not contain, and has never contained, thimerosal, or aluminum. Also, in 2007 it was recommend that children receive an MMR-V shot which contained the chickenpox vaccine.
Dosing schedules have changed from a single dosage given in 1963 at the age of 9 months to 1965 when it was then given to children at their first birthday. In 1976 it was given between 12 to 15 months. 1989 raised the recommendation from a single dose to two dosages with the second dosage being given between 4 to 6 years of age. Efficacy shows that 95% of children vaccinated at 12 months develop antibodies while that number raised to 98% for children dosed around the age of 15 months. More than 99% of children who receive both dosages develop immunity with the first vaccine being no earlier than their first birthday.
Measles is going to be something that, as a world, we struggle with as outbreaks are common in other countries. With global travel, and destination places such as Disneyland, it make sense as to why the number of cases has increased. When it comes to vaccinating your children, you have to do what is best for your family. One of my patients shared the following article with me this past week, and I want to share it with you as it is written by an allopathic doctor who talks about his frustrations with fear, and the realities of disease treatment. Please take the time to read the article.