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June 23rd, 2019


Measles Has Returned

Measles Virus

 

Measles has returned. After having been declared eliminated in 2002, measles has returned, right here in northwest Pennsylvania. Certainly, a closer look at measles is timely.

 

History

 

In the ninth century, the Persian physician Rhazes was the first to describe measles. In 1757, the Scottish doctor Francis Home first attempted to make a vaccine.

 

Because of measles high level of contagion, it spread rapidly in island nations with no intrinsic immunity. An 1848 outbreak in Hawaii killed nearly a third of the population. An 1875 outbreak in Fiji likewise killed nearly a third of the population, in only four months.

 

In 1916, 12,000 people died of measles, three out of four of them being children under 5-years-old.

 

By the 1950s, deaths dropped to 400-500 a year, mostly because of antibiotics and public health measures. However, there were still an estimated 48,000 hospitalizations a year from measles-related ear infections, diarrhea, and pneumonia. An estimated 1000 children a year developed measles related encephalitis causing intellectual disability or death.

 

Finally, with school vaccination requirements and federal funding, measles was eliminated in the US in 2002. However, with some Americans desiring not to vaccinate, measles has begun to reappear.

 

Contagion

 

Measles is one of the most contagious diseases. At least 90% of susceptible household contacts will acquire the disease from an infected patient. Patients are typically contagious for over a week, beginning 3-5 days before the rash first appears until 4 days after. However, patients with immunodeficiency may remain contagious for the duration of the disease. Measles is transmitted by respiratory droplets, which remain infectious for 2 hours whether in the air or on surfaces.

  

Susceptibility

 

Although the measles virus is usually regarded as affecting mostly children, persons of all ages are susceptible. Conditions dramatically increasing susceptibility are malnutrition, pregnancy, vitamin A deficiency, and immunodeficiency. Causes of immunodeficiency are AIDS, leukemia, cancer chemotherapy, and corticosteroid therapy.

 

Symptoms

 

The onset of symptoms typically occurs 7-14 days after exposure.

 

Symptoms typically include a high fever (often 104 degrees Fahrenheit), cough, runny nose, and inflamed sensitive eyes. An itchy rash usually appears a day or two later. The rash characteristically progresses from the head to the trunk to the arms and legs. Patients are usually most ill during the first or second day of the rash. With recovery, the rash disappears in the same order. The rash may not appear in severely immunocompromised patients.

 

Complications

 

While measles usually resolves unremarkably, when complications occur, they can be quite serious. Complications include pneumonia, reactivation of tuberculosis, blindness, hemorrhage, hepatitis, pancreatitis, and viral infections of the heart.

 

In pregnant women, measles can cause preterm labor, preterm birth, and spontaneous abortion.

 

Finally, 1 in every 1000 patients may develop measles encephalitis. Measles encephalitis can be fatal in 10% of victims and cause permanent brain damage in others. Rarely, measles can result in behavioral and intellectual deterioration and seizures beginning an average of 10 years after the measles episode.

 

Public Health Hazard

 

Measles is a public health hazard because of the seriousness of the complications and the potential to affect a large number of susceptible people in a short time. For this reason, measles has been a reportable disease in the US since 1912. Additionally, respiratory isolation is recommended for hospitalized measles patients during their period of communicability. A final recommendation is that exposed, susceptible healthcare workers be excused from work from the fifth to the 21st day after being exposed to measles. The US Centers for Disease Control certainly takes measles seriously.

 

Treatment

 

The treatment of measles is largely supportive. Fluids are used for dehydration from the fever, diarrhea, or vomiting. Medications to reduce the fever are also considered appropriate. Antiviral drugs are sometimes used, but without specific FDA approval. Vitamin A supplements appear to help prevent eye damage and blindness and have been associated with reduced mortality. Human immune globulins may modify the disease if administered soon after exposure, before symptoms develop.

 

 

Prevention

 

Fortunately, measles is largely preventable. A single dose of measles vaccine administered to a child older than 12 months induces protective immunity in 95% of recipients. However, endemic transmission of measles may return if measles immunity falls to less than 93-95%. A second dose recommended for school-age children renders immunity to 95% of those still susceptible after the first dose, a total protection rate of 99.75%.

 

Conclusion

 

Measles, once considered eliminated has returned. It is a public health issue for two reasons. First, the complications of measles can be severe, including blindness, neurological disability, and death. Second, this highly contagious disease can infect great numbers of people within a short time. But, inoculation against measles can confer almost perfect protection. Hopefully, after the current visitation, measles will not return.

 

Thomas Falasca, DO

 

References

 

Haelle, T. (2019, February 06). Why It Took So Long to Eliminate Measles. Retrieved June 4, 2019, from https://www.history.com/news/measles-vaccine-disease

Measles. (2019, May 30). Retrieved from https://emedicine.medscape.com/article/966220

Measles | For Healthcare Professionals | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/hcp/index.html

Measles | History of Measles | CDC. (n.d.). Retrieved from https://www.cdc.gov/measles/about/history.html

 

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