The Indiana Department of Health (IDOH) alerted clinicians today to a report from the Kentucky Department for Public Health of a confirmed case of #measles in an individual who attended a large spiritual revival gathering on February 17th and 18th at Asbury University in Wilmore, Kentucky while contagious. Measles is a highly contagious viral illness and reportable to the IDOH within 24 hours of suspicion.
Although older parents may be quite familiar with measles they experienced as a child, because it has become such a rare childhood disease, most are quite unfamiliar or no longer remember. Measles is identified through the outbreak of a generalized maculopapular rash and fever of 101 or greater and cough, coryza, or conjunctivitis and within the 21 days prior to symptom onset had some elevated risk of exposure, whether known or maybe having traveled internationally or even had contact with someone with a febrile rash illness. If all this criteria is met, then testing is available through the IDOH but prior authorization is required.
Ninety percent of those who are unvaccinated become infected with measles after contact. Interestingly, I remember well, my little sister suffering the measles when we were young, not long after moving back to the states from Holland and not long after we both had the chickenpox. We were military kids so were well immunized. While I escaped the measles, I later endured the mumps, so I suspect our MMR vaccine was a bit of a dud.
In the decade before 1963, when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated that 3 to 4 million people in the United States were infected each year. Also each year, among reported cases, an estimated 400 to 500 people did not survive.
Interestingly, in 2000, the Centers for Disease Control and Prevention (CDC) declared that the measles was eliminated in the United States, but that elimination status has risk threat of being revoked. More than 1,000 cases were reported in thirty states across the country back in 2019, for example (Rockwell, 2019).
One in Five Unvaccinated People in the United States who Contract the Measles will be Hospitalized, one in 1,000 will develop Encephalitis, and Nearly One to Three in 1,000 Children with Measles will Die from Respiratory or Neurologic Complications
Complications are more often seen in those with chronic disease, or in little ones younger than a year old, for which we do not offer vaccine. Women who had the measles themselves though extended protection to their babies through breastfeeding that first year of life, so once mothers began birthing who had received vaccine and not natural immunity then had babies who were exposed, became infected, and demised - or had reduced protection from not having been breastfed.
Measles is considered a severe illness in developing nations where living conditions, sanitation, water supply, healthcare, and nutrition are considered inadequate. Typically though, measles impacts those between the ages of two years and six years, with most every child having in prior to the age of 15 during its peak.
Identifying and reporting suspected #measles cases is an important part of preventing the spread of measles. The immunization is also a big part of the effort to minimize or eliminate measles in the U.S. and abroad, but this vaccine is part of the controversial #MMR vaccine so certainly, a significant number of parents are hesitant to offer this vaccine to their children, choosing to delay or decline entirely.
Measles typically presents seven to 14 days after exposure with a high fever, malaise (weakness), cough, coryza (inflammation of the nares), conjunctivitis (inflammation of the eyes), and pathognomonic enanthem (Koplik spots) on the oral mucosa, followed by a maculopapular rash (red bumps on a flat, red patch of skin). This is a bit different from #chickenpox which presents more like blisters on the skin, and are quite a bit more itchy.
The measles rash usually appears 14 days after exposure or three-to-five days after the first symptoms. It begins on the face at the hairline, even behind the ears, and spreads downward; it may not develop in individuals who are immunocompromised. The rash generally reaches the legs in two to three days, while the rash on the face correspondingly fades. With the onset of the rash, individuals tend to feel better. Additional symptoms include sore throat, muscle pains, and light sensitivity.
Individuals are considered contagious from four days before to four days after the rash appears. It is spread through contact, even through contact of contaminated surfaces. It has a cyclical reoccurrence, which is why we see outbreaks around the world about every two to three years. Diagnosis is confirmed through detection of serum measles immunoglobulin M antibody or measles RNA on real-time polymerase chain reaction testing of a respiratory specimen. Both blood and throat or nasopharyngeal swab should be collected. Urine can also be tested.
The MMR Vaccination
The liver attenuated measles vaccine became available in the United States in 1963, with an ineffective inactivated vaccine that was available until 1967. The vaccines available after this time became 97 percent effective in preventing transmission (Rockwell, 2019). The current vaccine is typically recommended at 12-to-15 months of age, and again at four-to-six years of age with at least 28 days between doses. College students are advised to be immunized, as are adults without evidence of immunity, and international travelers. Health care personnel are also expected to have documented evidence of immunity.
Adults born before 1957 are considered immune from measles. Others are considered immune if they have laboratory evidence of immunity, confirmation of previous measles, or documentation of adequate vaccination with at least one dose of a measles-containing vaccine administered on or after the first birthday for preschool-aged children and adults not at high risk or two doses for school-aged children and adults at higher risk, such as college students, healthcare workers, and international travelers. Those who received a dose of measles vaccine between 1963 and 1967 are recommended for testing or revaccination.
Religious exemptions are granted by 45 states and the District of Columbia, and 18 states allow philosophical (personal) exemptions. New York and Maine enacted legislation in 2019, joining California, Mississippi, and West Virginia, in allowing only medical vaccine exemptions, which is a policy supported by the American Academy of Family Physicians. There does seem to be a trend of states increasingly allowing non-medical #exemptions however (Rockwell, 2019).
Treatment of Measles
Conventional medicine doesn't offer treatment for measles. The symptoms of high fever and cold do not respond to antibiotics or cough medicine, through supportive treatment, such as rest and fluids, are helpful. Botanical medicine, #homeopathy, naturopathy, traditional Chinese medicine, and chiropractic care have all been useful in the treatment of measles and in strengthening the body's natural ability to heal.
References
Drutz, J. (2016). Measles. Pediatrics in Review, 37(5), 220-221.
Rockwell, P. G. (2019). The family physician's role in the prevention of measles. American Family Physician, 100(6), 329-330.
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