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Vaccine preventable measles roaring back

Anjali SubbaswamyMeasles was eradicated in the U.S. in the year 2000. Since then, increasing numbers of people are choosing not to vaccinate. In 2004, 37 people were reported to have measles. By 2014, it was 667, and 695 so far this year. 500 of the 695 were not immunized, and many of the rest were under immunized.

Measles is a viral respiratory illness characterized by a high fever, cough, runny nose, conjunctivitis, and a characteristic rash. The rash starts as spots inside the mouth, followed by a skin rash which spreads from the head to the trunk to the thighs. Patients are contagious from 4 days before to 4 days after the rash appears. Complications of measles can include encephalitis, pneumonia, croup, ear infection and diarrhea. Encephalitis can lead to permanent intellectual deterioration and seizures. In the pre-vaccine era, 500,000 cases of measles were reported annually, with 500 deaths per year, usually from pneumonia. The worldwide mortality rate for measles today is 100,000 deaths per year. Those at highest risk for complications of measles are children under the age of 5, pregnant women and immunocompromised patients.

In 1963 the first measles vaccine came out, followed in 1967 by the second generation vaccine which is still used today. It is a two part vaccine. The first dose confers adequate immunity in 95% of patients. The second dose attempts to capture the remaining 5%. Kids get their first dose between 12-15 months of age and the second dose at 4-6 years of age. Measles is vaccine preventable. The vaccine is safe.

For more information, I interviewed Dr. Walter Dehority, Associate Professor of Pediatric Infectious Disease at UNM, Co-Chair of New Mexico Immunization Practices Advisory Council.

Do grandparents need to be reimmunized to protect themselves and their grandchildren? All people born prior to 1957 are considered immune to measles because it was so prevalent in the population at that time. These people were never vaccinated and do not need to be vaccinated now. For people vaccinated during the years 1963 — 1967, it may be a good idea to either have their measles titers checked with a blood test, or to get reimmunized at a pharmacy or doctor’s office.

Are there any special precautions to take before travelling? For those who are already immunized, no additional precautions are needed. Children below 6 months of age are protected by maternal immunity, if their mother is vaccinated. Children 12 months or older should be vaccinated. Babies between 6-12 months of age can get their first vaccine early, for the purposes of travel, then restart the normal schedule at 1 yr of age.

Is the measles vaccine safe? Yes, it is safe. The most common side effects are a sore arm and fever. There is plenty of research showing that it does not cause autism. Because of that false claim made in years past, there is probably more research on the side effects of the measles vaccine than typical, all of which shows it to be safe.

What does it mean that measles was eradicated but has now returned? Eradication is when an infectious disease is no longer present in a country. Measles was eradicated from the US in 2000. It is concerning that the disease is returning in higher numbers every year, due to people choosing not to vaccinate. While the mortality rate is fortunately very low, people are still getting sick and missing days of work and school. Also, we should never forget that this disease can and did result in death on a regular basis in years past, and we don’t want to return to that time when we now have the vaccine to prevent it. An eloquent 1986 essay by the author Roald Dahl called “Measles: A dangerous illness” describes the death of his 7-year-old daughter Olivia from measles encephalitis in 1962, before the vaccine was available. Along the same lines, there is an article in the April 17, 2019, issue of the New England Journal of Medicine called “Measles in 2019 — Going Backward.” In this piece Dr. Fauci and his colleagues from the National Institutes of Health remind us that measles vaccination has prevented an estimated 21 million deaths worldwide since the year 2000.

More information can be found at cdc.gov.

Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to her at asubbaswamy@salud.unm.edu. Questions for Dr. Dehority may be directed to Dr. Subbaswamy’s email.

 

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