Mono-Gram - Measles update 1/13/2015

Measles - In Times Like These

Twas the week before Christmas, when all through the house not a creature was stirring, not even a mouse…… – except at Disneyland!

Current Situation

Who woulda thunk it! During one of the busiest weeks of the year at Disneyland and California Adventure theme parks - kids were exposed to and came down with MEASLES!

There have been at least 22 measles cases confirmed in multiple counties in California, and in 2 other states – Utah and Colorado. The shared link is a visit to one of the Disney theme parks in Orange County between December 17th and 20th. However, many of these cases have also visited other public places and locations throughout California while they were infectious. Most of the cases occurred in children who were unvaccinated, were under vaccinated, or were too young to be vaccinated. The source is probably an international visitor.

The Disease

Measles is a highly contagious virus that lives in an infected person's nose and throat mucus and spreads through coughing and sneezing. Symptoms include fever, cough, runny nose and red eyes and a red rash that usually 1st appears on the face and spreads to the rest of the body.

Historical Context

Measles is still the greatest vaccine preventable killer of children in the world today, with 14 children dying every HOUR! In the USA, prior to measles vaccination, virtually everyone came down with measles, resulting in 48,000 hospitalizations per year, 4,000 cases of encephalitis (brain infection) with risk of neurological consequences, and 450 deaths. One of every 1,000 children who contracted measles died in the US. In the 21st century, over the last 13 years, there have been 37-220 documented cases per year in the US, a 99% reduction in cases, with most originating from outside the US, and most occurring in unvaccinated children.

Health experts say the best prevention against measles is vaccination. While officials declared measles eliminated in the United States in 2000 because of a lack of continuous transmission, the illness is still brought into the country by foreign visitors or unvaccinated Americans.

The Vaccine

The long proven measles vaccines have been some of the most scrutinized vaccines concerning safety and adverse events in recent years. Now a 12-year study of measles vaccines, looking at over 700,000 doses, published on January 5th, 2015, found that adverse outcomes were unlikely.

A study by Dr. Andrew Wakefield, published in 1998, claiming that the measles vaccine caused autism, was widely covered by the media, and caused an “autism panic”. This has resulted in the plague of measles returning to areas where it had previously been eradicated, and is putting current generations of children at risk. The theory has been repeatedly disproven, but the effect lingers as resistance to the vaccine continues among small but vocal pockets of the population.

Local Concern

The rate of Personal belief exemptions (PBE’s, which allows parents to exempt children from vaccinations) in California has dropped 20% since 2013-14, with 2.5% of kindergartners opting out of vaccines, down from 3.1% the prior year. Overall, 46 of California’s 58 counties saw fewer PBE’s than last year.

However, after holding steady for years, the rate for entering kindergartners at Mammoth Elementary School increased dramatically to 12% this year, almost 5 times the statewide average. Inyo County rates range from 1% (Bishop) to 7% (Big Pine and Round Valley).

Measles outbreaks are a canary in the coal mine. People who refuse one vaccine may be spurning others, setting communities up for outbreaks of other dangerous diseases that are slower to spread, such as whooping cough. California is currently experiencing the worst outbreak of whooping cough in decades, with over 10,000 cases in 2014.

Despite the fact that it's one of the greatest health measures ever invented by mankind, there seems to still be a small residue of humanity that objects to the very idea of immunization. If you go around older cemeteries you can see the historical evidence of the childhood slaughter from pre-immunization days.

In California, parents have the legal right to what are known as “Personal Belief Exemptions”, or PBE’s, which allow them to exempt their child from all or some vaccinations. Although I disagree with this concept, I recognize their legal right to refuse vaccination for their children. They have the legal right to put their own children at risk for infection, complications, and death. However, my objection stems from the fact that I do not believe that they have the right to do the same for my child or grandchildren who may be in contact with their child.

What Should You Do?

• If you are an adult, it is unlikely that you need to do anything. If you were born before 1957, you are considered immune, meaning you probably had the disease. If you were born after 1957, you were probably immunized, and do not need to do anything further, unless you are traveling internationally, or you are a healthcare worker. Check with your healthcare provider for more information.
• Children should receive their first dose of MMR (measles, mumps, rubella) vaccine between 12-15 months of age, and a second dose between age 4-6 years, or prior to kindergarten entry. It is never too late to start!
• If your child has a rash, consult by phone with your provider before going in.

1. Most rashes are difficult to diagnose, and are not likely to be measles. For example, in the last few weeks, we have consulted on a possible case of chickenpox, which turned out to be hives, and a case of possible measles, which turned out to be another common benign viral infection called fifth disease.
2. Your provider may meet you in your car, or have you bypass the waiting room to be evaluated in a private location away from other children, or arrange to see you at times when there are no other children in the office or clinic.

• For healthcare providers, if you have a suspect case:

1. Mask the patient immediately and move them to a private area.
2. Call us immediately for consultation as to next steps.
3. Do not send the person to a laboratory for a blood draw.

• If public health determines that there is a suspect case in the community, all healthcare workers, children, and school/child care staff without documented immunity (vaccination or blood test) will be removed from work/school/child care from day 7 (day 5 for healthcare workers) after the first exposure to day 21 after the last exposure.