Friday, February 28, 2014

Measles on the rise?


Since it has been in the news recently and is hitting close to home with the exposure on BART,  Measles seemed like a worthy topic this week. 

Measles, also known as Rubeola is a very contagious respiratory virus. Infected people present with  high fever, cough, congestion and red eyes. After several days they will also develop a significant rash all over the body. These patients are clearly ill.. 
People are contagious as early as 2-4 days prior to showing any signs of the virus and may remain contagious until the rash is gone.


Complications are frequent.They range from ear infections to pneumonia, encephalitis and/ or seizures. 1-2 out of every 1000 cases are fatal. This is a serious illness. Unlike something like chicken pox, where some folks want to catch it so that they develop immunity. You really don't want your child to get the measles.
90% of unvaccinated people who come into close contact with an infected person will come down with the illness.



The routine Measles vaccine is combined with Mumps and Rubella and is referred to as the MMR
They used to sell the individual components but they haven't had them available separately for many years.
The first MMR  shot is routinely given to patients between 12-15 months and again between 4-6 years.
The vaccine is thought to be 95% effective. The second dose is given just to catch the occasional person who didn't get effective immunity from one dose and bumps the effectiveness up to 99%



Why do we wait so long before giving the protection to our babies?

Assuming that mom has been fully vaccinated (or less likely has had the actual measles) babies are born with passive immunity to the disease. This immunity starts to wane as they get older and is considered mostly gone by the time  they are between 12 and 15 months. If a child is vaccinated when they still have the maternal protection, the vaccine does not seem to be as effective.
Because of this, in our office we generally give the MMR at 15 months.
If you are traveling to a high risk area or there has been a clear exposure, the vaccine can be given as early as 6 months, but that shot won't count towards lasting protection and your child will still need to get 2 shots after the age of a year.

The Vaccination discussion is not an easy one.
I get it that as a parent, you are trying to do the very best that thing that you can do for your child. There is nothing trivial about this.
Unfortunately it can feel very difficult to find solid, balanced information about vaccines.
There is a lot of confusing and misleading information out there, especially on the internet. There are so many strong opinions.
My general rule of thumb is to discount the opinion of anyone who is rabidly one sided on either side of any discussion.

Facts do show that there has been significant decrease of a number of deadly illnesses since the advent of routine childhood vaccinations.
This is more than someone throwing statistics at me.
When I was just starting out as a nurse, fatal cases of Meningitis, and epiglottitis were common. I have seen first hand what a change there has been since the HIB vaccine became available.
Before routine use of the measles vaccine, there were about 500,000 cases of measles in the United States each year and about 500 deaths. Measles also led to about 48,000 people being hospitalized and another 1,000 people being left with chronic disability from measles encephalitis.

For my part, I choose to fully vaccinate my own children. It seemed to me to be the most sensible choice both for their health as well as the greater good in the goal of eliminating these diseases.

Certainly I have seen my share of patients having a miserable several days after shots.
It is absurd to pretend that that can't happen.
Luckily in all the years that I have been working in this office I have not had any patient have a serious, long lasting adverse consequence from any shot.

Of all the vaccinations out there, the MMR has had the worst of the reputations.
Study after study has shown that there is no link between between the MMR and autism.
http://www.immunize.org/catg.d/p4026.pdf, but there are still some folks reluctant to give their children the vaccination.

The MMR is a live vaccine and it is true that in some rare cases the reaction can be a little rough.
Interestingly, most kids are just fine the day of the immunization.
Typically the reaction comes along between a 7-21 days after the shot. This reaction may include high fever and rash. This is not thought to be contagious. It usually lasts only a day or so.
If your child is allergic to eggs, we are extra cautious when giving the vaccine. Some folks with a significant reaction to eggs may opt to get it at the allergist's office.
I have NEVER had any patient have an allergic reaction from the MMR or a serious post vaccination reaction other than about 20% who seem to get the fever the following week.




This year (2014) there have already been 15 reported cases of measles.
Most of those were travel related and most of the patients were unvaccinated.
Prior to this, The last large outbreak of measles in the U.S. occurred during 1989-1991, with 17,000 cases of measles and 70 deaths in California.  In 2013-2014, a large measles outbreak in the Philippines has resulted in over 1700 cases and 21 deaths. With so much traveling these days and higher numbers refusing to vaccinate, it is not surprising that we are seeing more cases here. 

Over the years, I have had many calls from parents worried about measles. I was able to reassure them that active cases of measles were very rare in California.  In fact, truth be told, I have not seen even ONE case of measles among my Noe Valley Pediatrics patients in all of the 26 years that I have been there.
I certainly hope that I never do.Unfortunately with more and more people opting out of vaccinations it doesn't feel like a very safe bet anymore.



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