Friday, May 26, 2017

Measles on the rise? 2017

Topic of the Week: Measles 2017

Measles on the rise!
Summer often means travel. I have been getting lots of calls from families who have trips planned. The question is often whether or not their baby needs to get an early MMR. At this point, it depends on where you are going, but the answer may be yes.
From January 1 to April 22, 2017, 61 people from 10 states (California, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington) were reported to have measles. Minnesota in particular has an outbreak that the officials are keeping a close eye on.
There are also increasing numbers throughout Europe.
A measles outbreak is a bit like fire. There are embers out there. It is NOT a wildfire yet. Don't panic! A few hundred cases is a few hundred too many, but that does NOT mean there is a child with measles standing on every street corner. The next couple of weeks will be very telling. It is possible that the numbers of infected patients will spread dramatically. It is also possible that the infected individuals have been identified and quarantined and everyone can all breath a little easier.
Here are some facts about measles:
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. If you have a happy child, who is fever free who has a rash, that isn’t measles. Patients with measles are clearly very ill.
One of the reasons that it spreads so easily is that 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! If someone travels on a plane while they are contagious, we can see a faster spread that will be even harder to contain.
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. 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. The individual components have not been 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 chickenpox 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 years, 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. 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. 
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 first birthday.
Your insurance company also might refuse payment if the shot is given outside of the routine schedule. If that happens, be aware that getting an early, extra dose may be an out of pocket expense
It takes about 10-14 days to get any significant protection from the first MMR. For instance, getting an MMR for a 7 month old to protect them from a travel situation the same week is not going to do much of anything.
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. 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.
Since July 2016 when  SB277 was signed into law, it is now a requirement for all children attending schools in California to have the measles vaccine unless they have a medical contraindication. 
Several years ago when I was working on my very first measles post, one of my adult friends said to me, "We all got measles and survived, what is the big deal?"  My response was, "It is true enough that the vast majority of folks who get measles will recover intact and have lifelong immunity. However, one to two kids out of 1,000 will die; many more than that will be permanently harmed. That is too many when we are talking about something that can be prevented. That 1 child out of 1,000 matters."

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