Unless you’ve been on a desert island, you’ve been hearing a lot about measles lately. There’s a good reason for that: we’ve seen more cases (839 at last count in the U.S.) than any year since 1994. And at this writing we’re only in May. It’s hard to believe that in 2000, the disease was considered eradicated—i.e., gone—in the United States.
We’ll look at how and why this spike is occurring. But let’s first look at why we should be concerned about this increase. After all, many of us, myself included, went through measles and were perfectly fine. Isn’t the disease just another childhood rite of passage?
A Measles Primer
If your “exposure” to measles is primarily from reading Tom Sawyer, you’re not alone in this day and age; many people, including many physicians, have never seen it. That’s one of the problems. The fever, cough, and runny nose that occur during the early stages of the disease can look like a variety of other viruses. There are often white spots in the mouth known as Koplik spots early on, but they’re not always there. Even when they are, they can be missed if we’re not looking for them.
When a rash develops three to five days later, it might provide a clue to measles. But it might not be so obvious that’s what’s going on; many viruses cause rashes that can look similar. And while it is true that a provider’s suspicion for measles is a little higher these days, and while testing is available, in most settings the result doesn’t come back in time to be useful for the patient. (Testing is still important to know what’s going around in the community.)
While Tom recovered to tell a few more tales, others are not so lucky. About 1 in 1000 will get a serious complication such as pneumonia or a brain infection known as encephalitis; both can be fatal. There is also a complication known as subacute sclerosing panencephalitis (SSPE). While much rarer, SSPE strikes several years after infection and causes irreversible brain damage and death. (And as reported on these pages, research has suggested that infants who become infected have a much higher chance of getting SSPE than their counterparts who become infected when older.)
So…Why the Increase?
The Centers for Disease Control and Prevention (CDC) closely track the number of cases, and there’s lots of information regarding the latest numbers on their website. According to the CDC, many of the measles cases have clustered in communities with lower vaccination rates. Generally, for measles, 95% of individuals have to be immune to prevent significant transmission—this is known as the rate needed for herd immunity.
Even with lowered herd immunity, the virus has to be introduced into the community from somewhere. And per the CDC, that somewhere has usually been abroad. The measles vaccination rate is higher in the United States than in many parts of the world. With travel to virtually anywhere becoming increasingly easier, so is the ability of a nonimmune person to bring an unwanted souvenir of the trip—AKA the measles virus—back to America.
Lowering Your Baby’s Risk
Providers really do want to have that dialogue with you about vaccinating your child against measles. They want to get you comfortable with the idea that the risk of complications from a measles infection are so much greater than those from the vaccine. And while no fatalities from measles are listed in the current CDC statistics for the U.S., they are still a force to be reckoned with overseas.
Say you’re on board with the vaccine, but you have an infant. You’re aware that it’s normally not given until your child is 12 months of age. You want to travel, or maybe you’re one of the unlucky ones who lives in an outbreak area. What then?
It turns out that the vaccine (more properly, in this country, the MMR, which protects against measles, mumps and rubella) can be given down to six months of age for infants at risk. While the baby will still need two doses when he’s older, it does offer some protection for potentially exposed babies.
Is your baby under six months of age? You might think about avoiding unnecessary travel, especially abroad or to areas of outbreak in the United States. If you already live in such an area, it’s prudent to keep your baby home; the virus is incredibly contagious, and one infected person in a public building can circulate enough virus to infect others hours later. Finally, by all means, make sure everyone else in the household is vaccinated (if there are seniors in the household, they can be checked for natural immunity).
Nothing is a substitute for a full series of vaccines in offering protection against measles and its complications. The vaccine, however, may offer some protection if given within 72 hours of exposure. And it’s worth having a talk with your provider or infectious disease specialist as soon as possible about other measures that may help lessen the effects of the virus.
Viruses, as well as the risk of contracting them, come and go. Unfortunately, measles doesn’t look like it’s leaving anytime soon. Do what you can to reduce the risk of disease for yourself, your children, and those around you.
