“They want to say people are dying of measles. Yeah, in third-world countries they’re dying of measles,” Zedler said, shaking his head. “Today, with antibiotics and that kind of stuff, they’re not dying in America.” – Texas state Representative Bill Zedler
It’s in the news but should you really care? Unless you are an ant-vaxxer you likely received your immunization to the measles at an early age. You are likely protected against measles should you come in contact with it. It’s not until you, or especially your child, develops an odd rash and fever, that you start to question whether it’s possible.
What is Measles?
Measles is a highly contagious viral illness. You read right, VIRAL! Mr. Zedler, an antibiotic will not be effective against the measles. You might as well pop a Viagra and rub some calamine lotion on your chest to ward off the evil measles spirits.
Measles has all but been eradicated in North America thanks in part to immunizations. The last reported indigenous measles in North America was eliminated in 2002. While outbreaks still occur in North America, they are imported from other world regions, namely developing nations where vaccines are not readily available.
An odd rash develops in your toddler. She now has a fever. You start to worry about the circulating controversy over vaccinations. Is measles even a possibility?
Before anxiety gets the best of you, let’s talk about typical signs and symptoms of the measles. Clinical presentation can be divided into four stages.
Incubation Period. The incubation period begins after the virus enters via respiratory mucosa or conjunctiva (eyes), and last 6-21 days. Patients are typically asymptomatic.
Prodrome. The prodrome phase usually lasts 2-4 days. Symptoms include fevers, malaise followed by cough, coryza (inflammation of mucous membranes in nose), and conjunctivits. Koplik spots, which are whitish, grayish lesions, may appear on the inside of the cheeks. These spots generally appear 2 days before the classic measles rash.
Exanthem. The classic rash develops 2-4 days after the onset of fever. The rash starts in the face and spreads to the neck, upper torso, lower torso and into the extremities. The progression of the rash in this order is characteristic of the measles. It lasts for 6-7 days and fades in the order that it came. The rash’s appearance is raised and red which darkens to a brown tinge after 3-4 days. Fevers will peak 2 days after the appearance of the rash. Symptoms of sore throat, conjunctivitis, and fevers improve within 2 days of the appearance of the rash.
Recovery. Cough may linger 1-2 weeks after the rash disappears. Fevers beyond 3-4 days after rash likely represent a complication from the measles. Immunization to the virus is typically lifelong.
Complications to Measles
Aside from being highly contagious, the measles is potentially life threatening. Common complications from the measles include secondary infections such as pneumonia and other respiratory infections (croup, bronchiolitis). Bacterial superinfections occur in up to 5% of cases.
Diarrhea is the most common complication of measles and occurs in up to 8% of cases. Other gastrointestinal complications including hepatitis, gastroenteritis, and appendicitis may occur.
More severe complications of measles are neurologic manifestations. Viral encephalitis (inflammation of the brain) occurs in 1 in 1000 cases of the measles (by the way those are not astronomical odds). Symptoms are not unlike any other cause of encephalitis and include fevers, headache, stiff neck, vomiting, convulsions)
Subacute Sclerosing Panencephalitis (SSPE for short) is a fatal, progressively degenerative disease of the central nervous system. It typically happens 7-10 years after a measles infection. While the progression of the disease is poorly understood, so is the incidence or probability of becoming ill with the disease. It seems to be rare, and last estimates were 200 per 1 million cases. However the true risk is thought to be half of that. Those that were vaccinated are thought to be at less risk than those who were immunized from natural infection
Who is at Risk?
Whether immunized naturally by the virus or vaccinated, immunization to the measles is thought to be life long. Like all things in medicine, nothing is for certain. Although one has immunization, it is still possible to contract the measles if exposed.
Modified Measles is the term reserved for patients with measles who have already been immunized. The incubation period is longer and the symptoms are milder. Individuals are not highly contagious.
Immunocompromised patients are more at risk for measles. Groups of patients include those with HIV, AIDS, and Lymphoma. The presentation of measles is atypical and may not include a rash. These individuals are at greater risk from complications of the measles.
Pregnant women are at risk from measles associated complications. In addition, risk of low birth weight, spontaneous abortion, intrauterine death, and maternal death are significantly increased.
Treatment for the measles is supportive. Supportive therapy does not cure the cause but treats the symptoms. As in most supportive therapies, antipyretics like Tylenol and Ibuprofen are used along with fluids. Obviously any superinfection or complication of the measles may need additional tailored treatment.
The most effective way of avoiding the measles is to get vaccinated. Most individuals in developed countries are vaccinated as children. Through herd immunity we have been able to disrupt broad transmission of the virus.
There is an uncomfortably growing movement to not vaccinate. Because of this anti-vaccination movement, we are seeing transmission of a virus that we thought had long been eradicated in the U.S. Keep in mind our children are not fully vaccinated against the measles until age 4-6. Should a toddler come in contact with the measles, they are surely at risk.
The likelihood of contacting the measles virus is low, and the likelihood of contracting the disease is probably lower. However, it is still alarming that a potentially fatal virus is coursing its way through the air that we breath. It is more concerning that we have the power to control its transmission, and yet groups of people decide not to.
Medicine is science and science searches for the truth. You cannot pick and choose which truth to follow. If you do not want our vaccines, then please do not use our antibiotics, antivirals, cardiac stents, pacemakers, etc.