Measles is all over the news right now – Is it really a big deal?
I took care of a patient with measles about 10 years ago, and I will never forget what patients with measles look like. I walked into the exam room and saw this 3 year old, it was unmistakable, she looked so sick! The child had been referred to the ER where I was working because she was very ill, but she was also was known to have been exposed to a measles patient in the waiting room at her doctor’s office. My patient was there for her well child check at just the same time that a 7 year-old who had just traveled to Switzerland was in the office with a fever which turned out to be measles.
Measles is much more contagious than most illnesses. If you are in a room and you aren’t vaccinated, there is a 90% chance that you will get the virus, even if you are in the room up to 2 hours later. That’s how long the virus particles can stay suspended in the air and it infects just about everyone it comes into contact with.
The incubation period is typically 11-12 days between exposure and symptoms starting. It can be as early as 7 days or as long as 21 days in rare cases. That’s why a kid can be perfectly healthy and fly home from their European vacation and then get sick when they get home and spread it all over. Plus, symptoms will basically be a cold for the first few days, then this horrific rash appears 3-4 days after the first symptoms start.
Anyone who is vaccinated should be protected against getting the disease, but there are a few people who don’t make immunity. Sometimes they have gotten 2 shots which is the recommended number, and they just didn’t become immune, but there was also a period of time when researchers were trying to find the optimal timing for which ages to give the vaccine so it generated good immunity. If you were born between roughly 1965 and 1989 kids were routinely only given one dose.
To hear a first hand account of a vaccinated teenager who got measles during the 1990 outbreak listen to the story here.
Measles mimics other illnesses…at first. it looks like any other cold for the first several days, and a patient is contagious for 4 days before the rash starts until about 4 days into the rash. By the time they are very sick, and you can tell they have the measles, its too late to prevent spreading it. That’s why our only reliable prevention is to vaccinate everyone.
Complications are common. Encephalitis happens in ≈1 in every 1,000–2,000 cases of measles. Encephalitis is inflammation of the brain which can result in permanent brain damage. Measles death rate is relatively high too: 2-3 deaths for every thousand cases. For comparison, the death rate last year for influenza was under 1 case per 100,000 cases. Compare that to 2-3 per 1000
Measles can also cause something called Subacute sclerosing panencephalitis (or SSPE) – this is a progressive neurologic disorder that starts showing symptoms 7–10 years after you’ve recovery from the initial primary measles virus infection. It’s very strange. SSPE manifests as mental and motor deterioration, which can progress to coma and death. SSPE occurs in ≈1 of every 5,000 reported measles cases; rates are higher among children who are under 5 years of age when they get measles.
So, now it’s starting to make sense why there are so many news stories about measles right now. Cases are very high this year and can turn into an outbreak very quickly if a population of people is not well vaccinated. You also now know that you don’t want to get measles. How do you avoid it?
Read more: What’s So Bad About Measles: Symptoms and the MMR or listen to Episode 61 of The Pediatrician Next Door Podcast.
