Measles Outbreak! Disneyland not so magical

The recent outbreak of measles at Disneyland is a reminder of how infections that once were eradicated can re-emerge in the 21st century. The California Public Health Department had 59 confirmed cases since the outbreak started in December. Several more cases were confirmed in states outside of California, like Mexico, Oregon, Washington State, Colorado, and Utah. There are reports that the outbreak may have started at the Anaheim park between December 15th and 20th.

Since these confirmed cases, there has been a push for unvaccinated individuals to stay away from the theme parks or get vaccinated. Children younger than 12 months should not be taken to these parks or infected areas, as they are unable to get the vaccine and thus are susceptible to the infection. It is important to remember that this infection has moved away from the parks and into schools and other communities.

This recent attack begs the general public to re-visit the age old anti-vaccination discussions since the 1800s. In fact, there was the Vaccination Act of 1853 that ordered mandatory vaccination for infants up to 3 months old. This Act extended the age to 14 years in 1867. Of course, these age thresholds have changed. The World Health Organization (WHO) recommends the first dose of vaccine to be given at age 9 months in high risk areas, and 12 months in low prevalence areas.

Fear of the measles vaccine causing autism is based on no actual evidence. Here is some evidence to back this statement:

Stratton K, Gable A, Shetty P, McCormick M. Immunization safety review: Measles-mumps-rubella vaccine and autism. Washington, DC: Institute of Medicine, National Academies Press; 2001.

What the heck is measles?

Measles is an infection that is a viral infection that causes a rash, fever, and a cough. The virus can be spread from person to person.

There is a vaccine that can prevent measles. It is called the MMR vaccine. This vaccine is unique in that it protects against, measles, mumps, and rubella. People need 2 doses of this vaccine to protect against measles. So who is at risk?

• Children who are too young to receive the vaccine or those who do not vaccinate
  
• People who did not receive the 2nd shot
• People who have received the shot but it did not work well

What are the symptoms?

The initial symptoms may include the following:

    1. Fever as high as 104 F
    2. Feeling sick, as if you have the flu
    3. Loss of appetite
    4. Spots in the mouth that look like grains of salt

After the initial symptoms people start feeling better after 2 days after the rash starts. By day 3 and 4 the rash turns brown and goes away.

The skin might peel or flake off.

Other symptoms include cough, shortness of breath, chest pain, or headache.

How can you make a diagnosis of measles?

The clinical history is most important as is the physical exam.

Anti-measles IgM and IgG is generally detectable in 3 days after the appearance of the rash. It may be negative on the day of the rash and as well as 30 days after the rash appears. So getting to your doctor as quickly as possible is important. However, please notify your doctor that you are coming as measles is infectious and the people in the clinic might be susceptible to the infection upon your arrival.

Is there a treatment for measles?
Not particularly. The treatment for measles is supportive. There is some role for vitamin A in certain settings. Intravenous fluids and treatment for any super imposed infections is critical. This means that there might be pneumonia or ear infection on top of the acute measles infection,

Has the recent outbreak affected your perspective on vaccinations?

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