Sunday, July 23, 2017

Measles Q&A

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Attention Parents- As announced by the County of Orange Health Care Agency on January 21, 2015, Measles has now been confirmed in 22 Orange County residents. They report that “of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized.” They remind us that “vaccination is critical to prevent the ongoing spread of the disease.”

These new statistics are striking given that measles was felt to be eradicated from the US 14 years ago. (Normally, we have zero cases of measles in Orange County each year). There likely have been cases beyond this that just have not been diagnosed; there are likely to be many more cases. Since most parents have never had or seen measles, we thought we would give a little instruction on the illness.

Fever is usually the first symptom and it usually starts eight to twelve days after a susceptible (or non-immune) patient is exposed to a contagious measles patient. The

Head and shoulders of boy with measles.  Courtesy of the Centers for Disease Control and Prevention

Head and shoulders of boy with measles.Courtesy of the Centers for Disease Control and Prevention

rash usually starts two to three days after the fever starts (usually about 14 days after exposure but can range from 7 to 21 days after exposure).

The rash starts at the hairline and then moves to the face and neck and then down the body. The rash usually lasts about five to six days. The rash is a red blotchy rash that is composed of small red spots and bumps, but often looks like large flat blotches that coalesce with other blotches. Other symptoms of measles are runny nose, cough, poor appetite and conjunctivitis (pink eye).

Some patients develop some small red spots with bluish-white centers (called Koplik spots) on the inside of the cheeks (inside the mouth, e.g. on the buccal mucosa) two to three days after the fever and cold symptoms have begun but before the rash occurs.

An infected person is contagious starting four days before the onset of the rash (which means one to two days before any symptoms are present) and remains contagious until four days after the rash appears.

Measles is highly contagious and is spread through the air via infectious droplets. A contagious person can spread the virus to anyone sharing the same air space (e.g. in the classroom, home, waiting room, gymnasium, restaurant, plane, etc.) when the contagious person is present and for up to an hour after the contagious person leaves the said area.

How dangerous is Measles?
Death occurs in about 2 people for every 1000 reported cases.  Several measles patients will report at least 1 complication which can be as mild as diarrhea and ear infections and as serious as pneumonia and acute encephalitis.  In general, kids with measles look super sick and feel miserable.

How can you protect your child?
Get your child vaccinated as soon as you can if he/she has not been vaccinated. The vaccine comes in a combination vaccine that includes measles, mumps and rubella (MMR). The first dose is given at one year of age and the second dose is generally given at four years of age.

How effective has the vaccine been?
The vaccine was licensed in 1963. Before the vaccine, there were about three to four million cases of Measles in the US every year. By 2004 there were only 37 cases per year. However, since then there has been a rise in cases (e.g. 644 in the US in 2014) and this is mainly in people that have not been vaccinated.

What can be done if someone is exposed to measles?
If the exposed person has not been vaccinated, the MMR vaccine may prevent the disease if given within 72 hours of exposure and the patient is at least six months of age. If the patient is under one year of age, he or she will still need to get two doses of the MMR vaccine after the age of one year. Injected immune globulin may prevent or lessen the severity of measles if given within six days of exposure. This is presently not available at SOCPA but can be obtained at the Public Health Department. Immune Globulin is recommended for children under 15 months of age who have not been immunized and have been exposed in the last six days. If the MMR vaccine is given, then no need to give the Immune Globulin.

It a patient has had at least one MMR vaccine, they can be considered immune. They can help ensure their immunity by getting their second MMR vaccine if it has been at least one month since the first dose.

What about home quarantine for an exposed person?
An exposed patient should be home quarantined starting seven days from when the exposure occurred through 21 days after the last exposure. This is to watch for symptoms.  If symptoms of measles do occur, the person should be isolated until four days after the rash has been present and the public health department will need to be contacted.

Treatment?
There is no treatment other than supportive care (nutrition, fever control, rest, hydration). Vitamin A once a day for two days has been shown to reduce the risk of death in children under two years of age.  As such, Vitamin A is recommended for all children with acute measles.

If you have questions or concerns about measles symptoms or your child’s vaccine history, please contact our office.  For additional sources of reference, please visit these links:

Orange County Public Health- Measles
Centers for Disease Control and Prevention

The contents of this web site are provided as an informational tool. This is not intended to replace medical advice or care administered by a healthcare professional. Common sense should always be used when referencing this site. If, at any time, you feel your child is experiencing a medical emergency, call 911 immediately.

By Terence Chu, MD

Terence Chu, M.D.

Dr. Chu has been with SOCPA since 2001 and provides care in our Lake Forest office.

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