Should I be concerned about the measles?

The Centers for Disease Control and Prevention recently announced that the United States currently has the most measles cases in 20 years and the most since homegrown outbreaks were eliminated in 2000.

As of May 23, the confirmed case count for 2014 was 288 and growing for 2014, according to the CDC. The number includes 138 cases from Ohio, where the biggest outbreak is ongoing. (A check on the CDC website this week showed that the number has risen to 397 as of June 6.)

Why are the numbers on the rise and what can we do about it? Here are some common questions that you may have about the measles:

Q: So what’s the big deal about measles?  Kids just get a rash, right?

A: One of the classic infectious diseases of childhood, measles (also known as rubeola), is a highly contagious viral infection.  This vaccine preventable disease is characterized by red eyes (conjunctivitis), a cough (pneumonitis or inflammation of the lungs) and a red, flat rash that begins on the head and descends towards the face, trunk, back and legs.  Fever is often seen during the development of the rash.  While the infection resolves spontaneously, approximately 1 of every 1000 infected individuals will die.

Q: Can you really die from the measles?

A:  Infection of the lungs (pneumonitis) or brain (encephalitis) can be lethal.  Infection of the lungs by the virus elicits an intense inflammatory response which destroys the surrounding tissue.  Twenty percent of children with measles develop pneumonia.  Subsequent infection with bacteria leads to fulminant pneumonia

Lung infection accounts for approximately 60 percent of the deaths associated with measles. Brain infection, characterized by persistent fever, headache, sleepiness and progression to coma occurs in 1 to 10 per 10,000 cases and accounts for the remaining number of deaths from this disease. 

Q.  I thought that vaccination prevented measles.

A: It does. Prior to the licensure of an effective measles vaccine in 1967, there were approximately 500,000 to 700,000 cases per year accompanied by 500 to 700 deaths. Following vaccine introduction, the incidence of measles in the U.S. fell by 98 percent. Between 1989 and 1991, there was a resurgence in the U.S. with more than 55,000 cases reported nationally and 123 deaths; most of these cases were among children less than 5 years of age.  Reduced vaccination rates among young children (50 percent) were the presumed reason for this outbreak. Following this outbreak, the incidence of measles in the U.S. declined to less than 500 cases per year and measles were declared eradicated in the U.S. in 2000; in 2004 only 37 cases were reported.

In this latest CDC report, most of the 288 cases occurred in 15 specific outbreaks and over half of these cases occurred in adults. No deaths have been reported.  Ninety-seven per cent of these cases were imported from other countries and included Americans travelling abroad as well as foreign nationals entering the U.S.  Over half of these cases were associated with travel to the Philippines. 

Travel to Africa, Europe and other parts of southeast Asia were also associated with cases. Only 10 percent of cases occurred in vaccinated individuals.  Among infected, unvaccinated Americans, 85 percent refused vaccination for religious or philosophical reasons.  Interestingly, the densest outbreaks were centered in the Amish communities of Ohio and in California, where parents can decline vaccination without medical reasons.

Q: What can I do as a parent?

A: As discussed in my blog on pertussis or whooping cough, vaccines not only protect the individual who is vaccinated, but in fully vaccinated community, the incidence of the disease is lowered and provides immunity to everyone, including the unvaccinated.  The current outbreak demonstrates what can happen when a vaccine preventable disease is introduced into a less than fully vaccinated population.  Perhaps you have noted a common theme to my blogs. Vaccines work.  Get them for your children and get them for yourself.  If you are planning a trip this summer to a measles endemic region, make sure you are up to date.

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