Friday, January 16, 2015

Measles outbreak 2015

Measles on the rise?

I first blogged about measles back in February 2014 when we had a small outbreak here in the Bay Area. Remember the cases on Bart? Since it has been in the news recently with 17 new cases in Disneyland in late December, measles seemed like a topic worth revisiting. At last check this current outbreak has spread to 4 states with 26 people diagnosed. 

From January 1, 2014 through November 2014 the World Health Organization reports that in the Philippines there were 55,388 suspected cases of measles, 19,041 confirmed cases and 107 deaths from the illness. As of November 29 2014,  25 US travelers who returned from the Philippines have become sick with measles. Most of these cases were among people who are unvaccinated. The World Health Organization and the Philippines Department of Health are working to control the outbreak.

During the same time period in this country the CDC reported 610 cases. This does NOT include the ones in Disneyland. In 2013 we had less than 200 reported cases country wide. Another report found that in 2002 the percentage of kindergarten children who were vaccinated for measles was 95%. That percentage has dropped to 92%. Houston, we have a problem!

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 or 4 days after the symptoms are all clear. This virus is so virulent that ninety percent of unvaccinated people will catch this virus once they are exposed.  What is even more alarming is that it can remain on surfaces or even in the air 2 hours after someone has sneezed or coughed!

Complications are frequent. They range from ear infections to pneumonia, encephalitis and/or seizures. 1-2 out of every 1,000 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.

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. For the second dose we have the option of combining it with the chickpox vaccine called Varivax. That combo vaccine is called Proquad or MMRV. The MMR 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%. It can be given earlier than 4, but we aren't too concerned about the timing of the second dose as long as our patients have gotten the first one. 

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

Assuming that mom has been fully vaccinated (or less likely has had the actual measles) infants 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 the babies 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. In our office we follow the standard recommendation and generally give the MMR at either the 12 or 15 month visit. 

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 a 2 shot series 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 data 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 chose 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 the MMR and autism,, 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.

As noted earlier, we are seeing the largest spike in cases in many years. 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 27 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.

 Here is another good article about how fast measles can spread 

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