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February 2, 2015 by Dr. Alfred L. Shearer, Pediatric Associates

Measles is a very serious and very contagious disease that is unfortunately making a comeback in the United States. Measles is an acute viral illness characterized by fever, cough, runny nose, conjunctivitis, extensive rash and characteristic spots in the mouth. The virus is transmitted airborne and is spread when a person coughs, sneezes or breathes. The symptoms develop over a period of two to three weeks and may progress to severe complications such as ear infection, pneumonia, croup and diarrhea. Acute encephalitis occurs in approximately 1 out of 1000 cases and death occurs in approximately 3 out of 1000 cases. Measles is one of the most contagious diseases and since it is viral, there is no specific treatment available.
The measles vaccine has been available since 1963 and works by stimulating the immune system and provides long term protection against the disease. It is available in two forms, the MMR (measles-mumps-rubella) and the MMRV (measles-mumps-rubella-chickenpox) and the two doses that children receive provides immunity in 99% of vaccine recipients. Children receive their first dose of measles vaccine at one year of age and their second dose at four years of age. After introducing the second dose of MMR in the early 1990's the incidence of measles declined to extremely low levels (<1 case per 1 million population). In 2000, an independent panel of international experts reviewed available data and unanimously agreed that measles was no longer endemic in the United States.
In the past 15 years, most cases seen in this country resulted from importation of the virus from other countries. However, a disturbing decrease in immunization of children in certain areas of the country have led to increasing number of measles cases, as evidenced by the recent outbreak in January 2015 which has been traced to Disneyland. During that one month, there have been over 100 cases of measles in the United States which is more than is usually seen in an entire year. The virus was thought to have been brought to Disneyland from outside of the country, but has spread further due to low vaccination rates - the majority of people who got measles were unvaccinated. Unfortunately, many secondary cases are developing in people who where exposed to the initial group, allowing the virus to spread from California to 13 other states. People are contagious for several days before they develop the symptoms of measles, allowing them to expose others before they even know they are sick.
There have been no measles cases in Alabama related to the recent outbreak, but health official remain on guard and continue to emphasize the importance of timely childhood vaccinations. The best way to prevent measles is to have the MMR vaccine. Children should continue to receive the vaccine at one year of age and again at four years of age. However, children who are at risk of catching measles may receive the vaccine as young as six months of age. This might include children who live in an area where there is an outbreak of measles, children who are in close contact with someone with measles, or any infant who is traveling outside of the country. Babies younger than six months of age usually have some immunity passed on from their mother, but if exposed may receive immune globulin to help prevent infection. Adults should also check to see if they're fully vaccinated, and if they are not sure if they were vaccinated in the past, then having the MMR again will not cause any harm. Adults born prior to 1957 lived through several measles epidemics prior to the development of the measles vaccine and therefore are almost all immune to the disease.
It is important for anyone infected with the virus to avoid spreading it to other people. Infected people should avoid day care, school or work for at least four days from when they first developed the measles rash. They should especially avoid people who are more vulnerable to the infection, such as young children or pregnant women.
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