Updated: Dec 10, 2019
And if you listen to the news, it seems like there is a new outbreak of measles everywhere recently.
There have been pockets around the United States and most recently in Samoa. This measles outbreak in Samoa has left over 60 people dead so far.
Lack of access to health care has been associated with surges in measles cases in some under served countries. However, the main reason for Samoa’s measles outbreak appear to be rooted in recent anti-vaccine activism.
The mis-information campaign by individuals or groups, commonly known as anti-vaxxers, who are opposed to science, evidence based medicine and facts has literally put the health of the world at risk.
Measles is a rare disease that most physicians have not seen in years, and there are many who have never seen a case of measles in their professional careers.
So what is this disease?
What does it do?
Why new outbreaks a big deal?
Measles was declared eradicated in 2000 largely due to the success of the vaccine. However, so far in 2019 there have been over 700 individuals diagnosed with measles in the United States alone. Cases have been reported and continue to be reported in multiple states.
This increase in measles diagnosis is multi factorial but largely related to increased international travel and increasing number of individuals who opt not to get vaccinated against this disease.
What is measles and why is this outbreak a big deal?
Measles is one of the most contagious viral diseases that we know of. The measles virus can remain suspended in the air for up to two hours. It occurs worldwide.
Infection with measles is characterized by fever, weakness, cough, inflammation of the mucous membrane in the nose, red eyes, followed by a widespread rash known as exanthem.
Because it is so contagious, approximately 90 percent of those individuals exposed to measles will develop the disease.
Measles is thought to be contagious from five days before the appearance of the rash to four days afterward. It can be transmitted in public spaces, even in the absence of person-to-person contact.
The median incubation period for measles is 13 days and begins after the virus gains entry via the respiratory mucosa or conjunctivae. Those infected are usually asymptomatic during the incubation period.
The dissemination of measles virus due to the presence of the virus in the blood (viremia) causes a variety of clinical manifestations and complications.
A second viremia occurs several days after the first, coinciding with the appearance of symptoms signaling the beginning of the prodromal phase.
The prodromal phase lasts a few days but may persist for as long as a week. It is defined by symptoms that include fever, malaise, and anorexia, followed by conjunctivitis (inflammation causing red eyes), inflammation of the mucous membrane in the nose (coryza), and cough.
About two days prior to onset of the skin rash, those infected may develop an enanthem characterized by Koplik spots. Koplik spots are small, whitish, grayish, or bluish elevations with a red inflamed base. They are usually seen in the mouth opposite the molar teeth.
Koplik spots generally last 12 to 72 hours. Koplik spots often begin to slough when the skin rash appears.
The typical skin rash of measles arises approximately two to four days after onset of fever. It classically begins on the face and spreads to involve the neck, upper trunk, lower trunk, and extremities. The palms and soles are rarely involved.
Clinical improvement typically occurs after 48 hours of the appearance of the rash. After three to four days, the rash darkens to a brownish color and begins to fade. The rash usually lasts six to seven days and fades in the order it appeared.
Cough may persist for one to two weeks after measles. The occurrence of fever beyond the third to fourth day of rash suggests a measles-associated complication.
Immunity after measles virus infection is thought to be lifelong. That means, once you have been infected it is unlikely you will get infected with the virus again.
However, measles virus-induced immunosuppression may lead to secondary bacterial and viral illnesses including pneumonia and diarrhea, which cause the majority of measles-related morbidity and mortality. Infection with measles can weaken the immune system for a prolonged period, and may be responsible for the reported mortality up to three years after the initial infection. Interestingly this does not occur with the measles vaccine.
Complications occur in approximately 30 percent of measles cases.
Diarrhea is the most common complication and occurs in approximately 8 percent of those infected.
Most deaths are due to lung infections or swelling of the brain (encephalitis). The risk of complications is increased in developing countries, where the case fatality rate is up to 10 percent.
Pneumonia (infection of the lung) is the most common cause of measles-associated death in children. It occurs in about 6 percent of children.
Neurologic complications associated with measles include swelling of the brain (encephalitis), acute disseminated encephalomyelitis and subacute sclerosing panencephalitis.
Encephalitis occurs in up to 1 per 1000 measles cases and usually appears a few days of the rash, typically day 5. Typical symptoms include fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma.
Acute disseminated encephalomyelitis (ADEM) is inflammation of the brain and spinal cord that occurs in about 1 per 1000 measles cases. ADEM is thought to be due to an immune response after measles infection. It may be triggered by a number of infectious causes.
Clinical manifestations of ADEM include fever, headache, neck stiffness, seizures, and mental status changes such as confusion, somnolence, or coma.
ADEM following measles infection is associated with almost a 20 percent mortality. For some reason, this is higher than mortality from ADEM due to other causes, which is only about 7 percent.
Groups at increased risk for complications of measles include immunocompromised patients, pregnant women, individuals with vitamin A deficiency or poor nutritional status, and individuals at the extremes of age.
The treatment of measles is supportive; there is no specific antiviral therapy approved for treatment of measles.
There is a role for vitamin A in certain settings. The World Health Organization (WHO) has published a comprehensive guide to the treatment of measles.
Supportive therapy includes antipyretics, fluids, and treatment of bacterial superinfections, such as bacterial pneumonia and otitis. Treatment of other complications, such as seizures and respiratory failure, may also be necessary.
Vitamin A deficiency contributes to delayed recovery and to the high rate of post-measles complications. In addition, measles infection may precipitate acute vitamin A deficiency and abnormal dryness of the conjunctiva and cornea of the eye.
Administration of vitamin A to children with measles is associated with decreased morbidity and mortality.
The WHO recommends that vitamin A be administered to all children with acute measles.
Vaccinate! Vaccinate!! Vaccinate!!!
Measles, mumps, and rubella vaccination — Vaccination has led to interruption of measles virus transmission in the developed world and affords protection to unvaccinated individuals via herd immunity.
To disrupt broad transmission, herd immunity must be maintained above 85 to 95 percent. The vaccine is safe and effective and there is absolutely no evidence that it is associated with Autism.
The anti vaccine movement is a highly motivated, well funded group of misguided individuals that dispute science and fact. For this reason they are very dangerous.
Unfortunately, their mis-information campaign continues to hurt the efforts of public and global health advocates. But the fact is, vaccines are safe, vaccines save lives.
Vaccination is the best way to protect yourself from this disease.
Please remember that medical information provided by us must be considered an educational service only. This blog should not be relied upon as medical advice and does not replace your physician’s independent judgement. Please seek the advice of your physician or healthcare provider regarding any issues related to your health.