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What’s Causing the Latest Measles Outbreak?

Posted February 6, 2019

Many people believe measles poses no public health threat. The highly contagious infectious disease seems relegated to another era or parts of the developing world.

But a recent measles outbreak in Washington state — where enough cases prompted the governor to declare a state of emergency — proves that the illness isn’t gone for good.

The reason: Families that shun the preventive measles vaccine, which is administered over two doses at ages 1 and 4, respectively, and provides lifelong protection.

Immunization is one of the most cost-effective ways to improve global health security. This boy is now protected against measles. Image credit: CDC Global via Flickr, CC BY 2.0

Immunization is one of the most cost-effective ways to improve global health security. This boy is now protected against measles. Image credit: CDC Global via Flickr, CC BY 2.0

“Most of the people that have been diagnosed [in Washington] are unvaccinated children,” says Kelly Orringer, M.D., director of general pediatrics at University of Michigan C.S. Mott Children’s Hospital. “In our practices, we almost never see children who are unvaccinated because their parents can’t afford the vaccine.

“More than 99 percent of the time in these cases, they’re refusing the vaccine.”

The measles vaccine has a small risk of minor side effects, such as fever or rash, and no link to autism.

Parents should instead focus on making sure their kids are immune to the virus, says John LiPuma, M.D., director of pediatric infectious diseases at Michigan Medicine, who recalls treating a measles outbreak among Philadelphia youths in the late 1980s.

“I cared for lots of children with measles and I can tell people, very sincerely, these are some of the sickest kids I’ve ever seen,” he says.

How measles spreads

A viral infection of the respiratory system, measles has no treatment.

And its initial danger lies in the ease of transmission.

Measles can spread via coughs and sneezes, and the infected droplets may survive for hours or days on surfaces. Traces of the virus, once expelled, also can live for several hours in a confined airspace, such as an airplane or bus.

Once exposed, the unvaccinated have little defense.

Ninety percent of them will contract measles following exposure to an infected person, according to the Centers for Disease Control and Prevention. A person cannot get measles more than once.

Why measles is dangerous

Still, the disease isn’t something children should experience at all.

The illness may take 7 to 10 days to shed via respiratory secretions or stools. Worse, it can often lead to severe complications that include pneumonia, conjunctivitis and encephalitis (swelling of the brain).

“Some of these young patients with encephalitis never fully recover,” says LiPuma. “This is a very, very serious disease.”

One or two of every 1,000 affected children will die from complications related to measles, the CDC reports.

Signs and symptoms of measles

An infected person won’t initially show signs of measles in the first one to two weeks.

He or she may then experience a fever and a telltale measles rash most commonly associated with the disease.

“It’s a very impressive, red, bumpy rash,” says Orringer. “It usually starts at the top — your face and scalp — and spreads down the body. Patients will also have some white spots in their mouth.”

Other symptoms include a high fever, cough, runny nose and red, watery eyes. These patients, Orringer notes, are very sick and very uncomfortable.

Preventing measles in children

Widespread adherence since a preventive vaccine became available in 1963 has helped the CDC declare measles “eliminated” following “absence of continuous disease transmission for greater than 12 months.”

Likewise, vaccination rates of 95 percent or greater create what doctors call “herd immunity” to decrease the risk of spreading measles.

That’s crucial for protecting children younger than 12 months who aren’t yet eligible for the shot. Orringer urges parents to check that friends, relatives and caretakers are vaccinated.

Still, Orringer and LiPuma note, the recent Washington outbreak — where transmissions occurred in an airport and at an NBA basketball game, among other places — should prompt hesitant families to take action.

“When we prevent diseases like measles, they’re not seen by the public. People tend to forget how dangerous they are,” LiPuma says. “Second, we’re up against a lot of misinformation widely available through social media and the internet.

“That’s a problem in helping people understand the risks of this preventable disease and the safe options that we have.”

Source: University of Michigan Health System

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