Measles Crash Course
• According to the CDC, measles, also known as rubeola, is a highly contagious, vaccine-preventable respiratory disease that can affect both adults and children.
• The measles-mumps-rubella (MMR) vaccine is administered to children in two doses for prevention — once at about 1 year and again at 15 months to 6 years old.
• This viral infection is transmitted primarily through respiratory droplets released from coughing and sneezing. These droplets can linger for more than two hours.
• The disease usually starts with a fever, cough, runny nose and red, watery eyes. Over the next few days, the infected person may notice tiny, white spots on the inside of the cheek before a rash.
• The rash, the symptom most indicative of measles, appears as small, flat, red spots around the hairline on a person’s face and spreads downward across the body. Small, red bumps may also develop over the flat spots.
• Measles can last for several days or weeks. Those infected are contagious an average of four days both before and after the onset of the rash.
With measles cases on the rise in the U.S., health department officials are advising everyone to protect themselves, regardless of whether their area is experiencing an outbreak.
As of April 4, the United States has recorded 465 cases of measles — the second-largest number since measles was virtually eliminated in 2000, according to the Centers for Disease Control and Prevention.
The CDC considers a disease eliminated when there is no continuous transmission of it in a specific area for at least 12 months.
So far 19 states, including Florida and Georgia, have reported cases of measles this year. On April 9, New York City Mayor Bill de Blasio declared a public health emergency for measles in parts of the city. A state of emergency was also declared in Rockland County, New York.
“Measles is really on the radar right now, especially with the situation in New York,” said Dr. Karen Landers, district medical officer and medical consultant for vaccines for the Alabama Department of Public Health (ADPH). Landers, who lives in Florence, has been practicing in pediatrics for 42 years.
As of March, the Alabama Department of Public Health had no confirmed cases of measles in the state in the last 12 months.
Dr. Wes Stubblefield, president of the Alabama chapter of the American Academy of Pediatrics, is a pediatrician at Infants’ and Children’s Clinic in Florence.
“The more people that are vaccinated against a condition creates a buffer so more people are protected, and that protects the people that truly can’t be vaccinated,” he said.
Measles is most known for the rash it causes several days after the disease is contracted, but by then the patient has already been contagious for several days.
Initial symptoms can include fever, cough, runny nose and red eyes, according to the CDC. Those who develop these symptoms should watch for small, white dots, also known as Koplik spots, inside the mouth. After the initial symptons, the familiar red, widespread rash can develop between one and seven days.
The disease can often be mistaken for other illnesses in its earliest stages, Stubblefield said.
“We just have to reacquaint ourselves with those signs and symptoms and raise that in our minds when we’re seeing patients with fevers and rashes and red eyes because the initial symptoms are relatively minor, and it might be confused for something else,” he said.
A quarter of those who contract measles are hospitalized, according to the CDC. Landers said complications are often more serious in young children, but adults are not immune.
“The complications with measles in very young children begin with the risk of not only developing pneumonia, or even a severe ear infection, but more specifically, the measles encephalitis that can occur, and people can die,” Landers explained.
Encephalitis means brain swelling, which can lead to deadly brain damage. The complication rate for measles is about 20 to 30 percent, according to ADPH.
“It is a very, very serious disease that we do not need to have in our population affecting our children and causing these terrible, long-term complications,” Stubblefield said.
CDC reports that anyone vaccinated who still develops measles will have a much milder case and be less contagious.
Landers said people born before 1957, when there was no measles vaccine, are highly likely to have already been exposed to measles. Once a person receives two doses of the MMR vaccine, he or she is considered protected for life. No booster vaccine is necessary.
Physicians, as well as many pharmacies and health departments, administer vaccines.
“We are just continuing to work to educate,” Landers said. “Obviously, I want to respect other people’s opinions, but I have to base it on science.
“I’ve been doing this 42 years. I’ve studied this all my career. I think it’s a real tragedy that people are not taking advantage of this vaccine with their young children when the opportunity to prevent a deadly disease is there. It really is very concerning to me as a physician.”
Landers said the local health departments will notify the community if a case is confirmed in the area. A single case is expected to cause 12 to 18 more cases, according to ADPH.
During investigation of a potential case, health department officials look at the person’s travel history, vaccine history and the clinical presentation.
The health department also performs a polymerase chain reaction (PCR) test, which is sent to another state with a measles laboratory, Landers said. This will determine if it is a true case of measles.
“Based upon that situation, we would, of course, vaccinate the contacts around the person if they had not been vaccinated, and notify the community that there is a case so that people could check their vaccine records,” Landers explained.
In the event of an outbreak, infants in the affected area as young as 6 months may receive vaccinations.
If a person is exposed, ADPH states that receiving a dose of the MMR vaccine within 72 hours “significantly reduces the chances of measles” developing. Taking immune globulin medicine may also reduce chances, according to the CDC.
The CDC said those who contract measles should stay home until at least four days after the rash appears, keep surfaces disinfected, and practice common habits for good hygiene.
Stubblefield said Alabama has a vaccination rate of more than 90 percent for the primary series of vaccines — including the MMR vaccine — which children must have before they enter school. He and other pediatricians, however, have noticed an increase in parents who have declined or delayed these vaccines for their children.
“The lower our vaccination rates go, the more common outbreaks will become,” Stubblefield warned.
Though pockets of people across the state and the nation still believe there is a link between vaccines and autism, as well as various health issues, Landers said these beliefs are not supported by science.
Several organizations, including Autism Speaks, endorse the MMR vaccine.
Stubblefield said the Infants’ and Children’s Clinic in Florence has a policy that states doctors will not take on patients who won’t get vaccinated.
“We feel very strongly about vaccination and the safety of vaccination and the effectiveness of vaccination,” Stubblefield said. “We feel that if we can’t agree on something that we feel so strongly about that we probably aren’t going to agree on much else, so we feel like it’s better that we just separate our care from those people who choose to do that. And that is their choice, but it is something we also can choose — whether or not we want to see those patients.”
Landers urges people to check their vaccine records.
“Make sure you’re vaccinated now. Make sure that you know your history and that your children are vaccinated,” she said.