Your family, your child & the U.S. Measles Outbreak
Parents in the U.S. have become concerned about the safety of vaccination; yet, not enough 21st century factual information about the real risks and benefits has been made available for discussion with this generation of parents. Some pediatricians have adopted a delayed vaccine schedule for childhood immunization. Some celebrities and lobbyists have become vocal vaccine opponents. But, when an outbreak at Disneyland leads to 14 states, including New York, with confirmed cases of Measles in 2015, there is a very real threat of history repeating itself in death and disease incidence in our nation.
The vaccine for Measles, Mumps, and Rubella (MMR) was developed in 1963. The Centers for Disease Control & Prevention (CDC) followed the incidence of these diseases, finding that by 2002, Measles was no longer endemic in the U.S. However, it could still be brought here through foreign travel and unimmunized persons. From 2000 through 2011, the CDC spent $440 million on global Measles control. Within our country, a Measles outbreak during 1989-1991 led to the federal program, Vaccines for Children, which covers uninsured, underinsured, Medicaid eligible, & Native American children. From 1994- 2013, U.S. vaccination prevented 732,000 premature deaths. However, multiple factors contribute to underutilization of the resources available and have now led to a renewed susceptibility within this country. These include fewer preventive visits (a recent study from 2000-2004 by the Medicaid Expenditure Panel Survey found that amongst over 8000 children ages 10-17, only 38% had a preventive visit in the previous year), noncompliance with multiple dose schedule, underestimation of the risk of vaccine-preventable disease, & problems with verification of prior immunizations. One in twelve U.S. children does not receive the 1st dose of MMR in time.
The Director of CDC’s National Center for Immunization & Respiratory Diseases, Dr. Anne Schuchat, has reported that in 2014, there were over 600 cases of the Measles in the U.S. This is the largest increase in the past 20 years. The Philippines is the primary source of the U.S. outbreak. Eighty four people infected were linked directly to the Disneyland outbreak alone.
A review of this disease and the real risks to families is both timely and pertinent. The Advisory Committee on Immunization Practices (ACIP) sets the guidelines for childhood and adult vaccination in our country. These guidelines can be found on the CDC website or the American Academy of Pediatrics website. The first dose of MMR is to be given 12-15 months age. If this is delayed, studies have revealed up to a five fold increase in risk of vaccine-related complications, such a seizure. The second dose is to be given 4-6 years of age. The vaccine is a live, attenuated virus, but prior to 1967, a killed virus vaccine (which did not fully immunize) was given. Vaccination during pregnancy is not advised. Children traveling outside of the U.S. prior to immunization should consult a physician prior to travel about the child’s health and travel itinerary.
The Measles is highly contagious in susceptible individuals. The virus can incubate for up to 21 days. Initial symptoms include malaise, anorexia, fever (>104 degrees F), runny nose, red eyes and cough. Koplik spots are bluish gray specks in the mouth (buccal mucosa) which can appear 1-2 days prior to the classic red rash. The rash may take 1-2 weeks to develop; it begins on the face and spreads to the arms and legs. Diagnosis is through serologic tests, viral culture, or (PCR) polymerase chain reaction tests. Samples of blood, nasal/throat swab, or urine can be tested. The general treatment of Measles cases is non-specific; it includes rehydration and Vitamin A supplementation. Newborns (up to 6mo.) and pregnant women exposed to known cases can be given antibodies to fight the virus (serum Immunoglobulin). Antivirals are occasionally used in treatment. Measles complications include ear infection, pneumonia, severe diarrhea, blindness, encephalitis (brain swelling), and death. During pregnancy, certain viruses can cause teratogenic effects (birth and developmental defects). Fortunately, Measles (also called Rubeola) is not one of these viruses. Measles can, however, cause premature labor, low birth weight, spontaneous abortion (miscarriage), and, if a woman has active disease at birth of newborn, the baby can develop neonatal disease. With Rubella (another virus covered by the MMR vaccine), teratogenic effects are seen. These can include intracranial calcifications, cardiac defects, neurologic disease, and cataracts. Women exposed in pregnancy to Rubella during the first 12 weeks can have up to 90% incidence of Congenital Rubella in newborns.
Parents of the 21st century must be “smart readers” and must initiate the conversation about childhood immunization, both in schools and the healthcare setting. It is important to not just accept the rumor-mill, commercialization of education, & things seen on TV or read in a magazine when it comes to the well-being of children. While a small percentage of children may be vulnerable to the complications of routine immunization, most children face greater risk in failure to receive timely immunization during childhood. As a nation, we can do a better job in tracking childhood immunization through a national registry program. Parents can initiate discussion between health advisory boards and school boards to ensure a safe environment for all. We all must remember that even 21st century access to information does not equal being “well informed”, so we must go beyond the surface to obtain the substantive knowledge that allows us to stand guard for our children, our future.
Dr. Afriye Amerson