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Measles hits New York

February 2

By now, you have likely heard about the measles outbreak.  This started at Disneyland and has now spread to 14 states.  The case in New York was a college student who recently traveled on Amtrak from New York to Albany.  We will describe Measles below, but we also wanted to alert you to some activities we are taking to be proactive.  If you are web enabled you will receive a message if the following applies to your child:

Patients who are 12 to 14 months may receive an MMR vaccine by scheduling a Nurse Visit, instead of waiting until the 15 month visit.

Patients who are 15 months and older who have not had an MMR vaccine and do not have a well visit within a week, should schedule a nurse visit within ONE week.

Patients who are 4 years of age and older, who have not had 2 vaccinations should schedule a nurse visit within ONE week.

Please note that Four Seasons Pediatrics has a vaccine policy which requires up to date vaccinations for diseases that can be spread within the practice waiting room.   Upon identification and notification about the need for vaccination for Measles or Pertussis (also in the midst of an outbreak), we will require vaccination within 7 days.  Failure to comply will result in discharge from the practice.  This policy stems from our best intention to protect individual children and children who visit the waiting room whether for a well visit or a sick visit.

Current Measles Outbreak

From January 1 to January 30, 2015, 102 people from 14 states were reported to have measles*. Most of these cases are part of a large, ongoing multi-state outbreak linked to an amusement park in California [1]. On January 23, 2015, CDC issued a Health Advisory [2] to notify public health departments and healthcare facilities about this multi-state outbreak.

The United States experienced a record number of measles cases during 2014, with 644 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination [3] was documented in the U.S. in 2000.

Measles cases and outbreaks from January 1-November 29, 2014. 610 cases reported in 24 states: Alabama, California, Connecticut, Hawaii, Illinois, Indiana, Kansas, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia, Wisconsin, and Washington. 20outbreaks representing 89% of reported cases this year. Annual reported cases have ranged from a low of 37 in 2004 to a high of 220 in 2011

Signs and Symptoms

Image of Koplik spots [4]

Picture 1: Mouth of a patient with Koplik spots, an early sign of measles infection.

The symptoms of measles generally appear about seven to 14 days after a person is infected.

Measles typically begins with

  • high fever,
  • cough,
  • runny nose (coryza), and
  • red, watery eyes (conjunctivitis [5]).

Measles Rash

Image of measles infection [4]

Picture 2: Skin of a patient after 3 days of measles infection.

 

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

After a few days, the fever subsides and the rash fades.

 

Transmission of Measles

 

Complications of Measles

 

Measles can be a serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.

Common Complications

Common measles complications include ear infections and diarrhea.

• Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.

• Diarrhea is reported in less than one out of 10 people with measles.

Severe Complications

Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.

• As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.

• About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or mentally retarded.

• For every 1,000 children who get measles, one or two will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

Long-term Complications

Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal disease of the central nervous system that results from a measles virus infection acquired earlier in life. SSPE generally develops 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness. Since measles was eliminated in 2000, SSPE is rarely reported in the United States.

Among people who contracted measles during the resurgence in the United States in 1989 to 1991, 4 to 11 out of every 100,000 were estimated to be at risk for developing SSPE. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age.

 

Measles Vaccination

 

Measles can be prevented with the MMR (measles, mumps, and rubella) vaccine. In the United States, widespread use of measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. Since 2000, when measles was declared eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 644 people in 2014. Most of these originated outside the country or were linked to a case that originated outside the coutntry.

Measles is still common in other countries. The virus is highly contagious and can spread rapidly in areas where people are not vaccinated. Worldwide, an estimated 20 million people get measles and 146,000 people die from the disease each year—that equals about 440 deaths every day or about 17 deaths every hour.

Vaccine Recommendations

boy getting shot from nurse

Children

CDC recommends all children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

International travelers

People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel—

• Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose at least 28 days later).

• Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.