Communicable diseases are frequently in the headlines. It Is most troubling when it is a disease that has been nearly eradicated and has the potential to cause serious illness, disability and death.
Measles has not been on the forefront of many providers’ diagnoses, because most practicing today have never seen a case. I have been working in health care for 38 years and have only seen it in textbooks or online research images.
Presently, measles cases are increased in every region of the world, including the United States. At the end of last week, there were 35 measles cases in the United States. Exacerbating the spread occurring in Florida, state officials deferred to parents and guardians to make their own decisions about school attendance despite clear CDC guidelines. The CDC recommends staying home until symptoms are gone, as well as keeping unvaccinated, exposed children home for 21 days.
According to the World Health Organization, COVID-19 has had an indirect effect on measles. Over a million children missed their measles vaccine during the pandemic. Travelers coming in and out of our country increase the risk of spread. One may be infectious and not know it yet. Those unvaccinated contribute to outbreaks.
Measles is considered one of the most contagious diseases. It can be transmitted without physical contact. My only personal knowledge or experience with measles was the story of my mother as a child. She lived on the northern coast of England during World War II. When she was 5, her neighborhood was bombed. While the rest of the family went to the bomb shelter, she was left in a steel crib in the living room, alone, because she had measles.
The disease is spread when an infected person sneezes, coughs or talks. It stays in the air and surfaces for two hours. Patients are contagious four days before the rash and until four days after. Incubation is 10-14 days after exposure.
It is a preventable with routine childhood vaccines. The vaccine rarely has side effects. Measles is one of the diseases in the MMR (measles, mumps and rubella) vaccine. Two doses of the vaccine is 97% effective. In 2019, we had the worst outbreak in 25 years, with 1,274 cases. It was associated with under-immunized communities. Unvaccinated children, children under 5, adults over 20, immunocompromised and pregnant women are at the highest risk of severe complications.
The vaccine is administered at 12-15 months and 5 years old. Massachusetts state regulations require all children from kindergarten to college to have received two doses. Children in child care and preschool need one dose. Child care workers need to be vaccinated. High-risk groups such as health care workers, health science students and international travelers should all have two doses. Infants 6-11 months old who will be traveling internationally should receive one dose. Adults who do not have evidence of immunity should receive at least one dose. Women planning to get pregnant who are not immune should get vaccinated at least four weeks before getting pregnant.
The disease presents as a rash starting along the hairline and spreads to the rest of the body. Other symptoms include cough, conjunctivitis, runny nose, fever, ear infections, diarrhea and pneumonia. It usually lasts one to two weeks. Diagnosis is done by testing of a swab of the nose or throat, or a blood test.
Serious symptoms and death can occur years later in the form of “subacute sclerosising panencephalitis.” Thankfully, it is rare. The virus lies dormant for six to eight years. It reemerges with personality and behavior changes, and disturbance in motor and neurological functions, including blindness. Death usually occurs in 1-3 years.
Those who should be concerned about getting measles include anyone who has not had measles or been vaccinated, babies under 1 year, adults vaccinated before 1968 and a small percentage who did not respond well to the vaccine. Travelers should also be concerned with the higher rates of measles in Europe and other countries. A blood test can verify immunity.
If you are exposed to measles, contact your health provider. If you get the vaccine within three days after being exposed, it will protect you against measles. If you cannot be vaccinated, you can be treated with immune globulin antibodies. It may not prevent the disease, but will make it milder.
If you have measles, you should isolate completely until you are well. State regulations require isolation for four days after the rash appears. Regulations also require health care workers who do not have immunity or documentation of two doses of vaccine to stay out of work from the fifth through the 21st day after being exposed.
Better yet, avoid getting measles. Be sure you have been vaccinated and have immunity.
Take care of yourself and someone else.
Juanita Carnes is a Westfield resident and a nurse practitioner with 38 years of experience in a hospital emergency department and urgent care facilities. She served 30 years on the Westfield Board of Health.
