Thursday, February 19, 2015

Health Care and Measles Update 2015

I have been writing this health care blog since 2007, and have published over 465 articles in the last eight years—sort of a Health Care 101 on all types of health care issues. For the most part, not too many of those have been updated with a follow up report—until this one. In 2012, I wrote an article about measles. With the recent outbreak in the US of this disease, just about wiped out fifteen years ago with only a few cases reported per year, has merited that this health care issue be re-examined.

Late last year, new cases of this very infectious disease started showing up. Since then, the number of measles cases in the United States has reached 141 patients in 17 states and the District of Columbia, federal health officials from the CDC have reported. The outbreak began at two Disney theme parks in southern California in December, the CDC says, and it's believed that the source of the infection was likely a foreign visitor or a U.S. resident returning from abroad.

Measles is still common in many parts of the world, including some countries in Europe, Asia, the Pacific and Africa, according to the U.S. Centers for Disease Control and Prevention (CDC). The majority of people who've gotten measles in the current outbreak were unvaccinated. This is not good. Despite the United States having declared measles eliminated in 2000, the virus has awoken anew, and with all the grace and predictability of a large bear coming out of sedation.

According to the UK Independent, Though best known for its telltale dappled rash, measles is a wildly infectious upper respiratory disease. Like the flu, it's airborne  –  and successful. It has a near-perfect infection rate: Put your baby in a room with a measles patient, and nine times out of 10, measles is coming home with you. In the space shared between you and a coughing, sneezing measles-ridden sap, the sweet oxygenated room air and unavoidable door handles are thought to remain infectious for up to two hours.

And measles delivers a double whammy because a person becomes infectious before they even know they have it. Four days prior to the rash is when most people become able to spread the love. Here's how the virus pulls it off.

Symptoms start out like standard-issue wintertime gunk: fever, cough, runny nose, red eyes. A few days of that misery and the decorative stage of the illness starts with a carpet of red lesions. Koplik's spots may appear before the rash  –  that's when the bright, beefy red of the inner cheeks become studded with lots of tiny, blue-white dots.

Complications from measles arise in almost one in three reported cases, and range from diarrhea (8 per cent) and pneumonia (6 per cent) to encephalitis (0.1 per cent) and death (0.2 per cent). It gets worse. For more details about how measles develops, visit this site: http://www.independent.co.uk/life-style/health-and-families/features/measles-makes-its-mark-all-over-again-one-of-humanitys-oldest-foes-is-back-on-the-increase-10054872.html#

According to the CDC it’s possible that measles could become endemic (constant presence of a disease in an area) in the United States again, especially if vaccine coverage levels drop. This can happen when people forget to get vaccinated on time, don’t know that they need a vaccine dose (this is most common among adults), or refuse vaccines for religious, philosophical or personal reasons. The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus, and two doses are about 97% effective.

Research shows that people who refuse vaccines tend to group together in communities. When measles gets into communities with pockets of unvaccinated people, outbreaks are more likely to occur. These communities make it difficult to control the spread of the disease and make us vulnerable to having the virus re-establish itself in the US. High sustained measles vaccine coverage and rapid public health response are critical for preventing and controlling measles cases and outbreaks.

People who received two doses of measles vaccine as children according to the U.S. vaccination schedule are considered protected for life and do not ever need a booster dose. Adults need at least one dose of measles vaccine, unless they have evidence of immunity.

Adults who are going to be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers, should make sure they have had two doses separated by at least 28 days. If you’re not sure whether you were vaccinated, talk with your doctor. Significant amounts of material about measles is available at the this CDC site: http://www.cdc.gov/measles/ .

Children are especially susceptible to measles. According to this website: http://kidshealth.org/parent/infections/lung/measles.html, infants are generally protected from measles for 6 months after birth due to immunity passed on by their mothers. Measles vaccine usually is not given to infants younger than 12 months old. But if there's a measles outbreak, or a child will be traveling outside the United States, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years of age.

The measles vaccine sometimes causes side effects in kids who don't have underlying health problems. The most common reactions are fever 6-12 days after vaccination (in about 15% of kids vaccinated) and a measles-like rash, which isn't contagious and fades on its own (in about 5% of vaccinated kids). As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information about vaccine recommendations. The measles vaccine should not be given to these at-risk groups:

--Pregnant women
--Kids with untreated tuberculosis, leukemia, or other cancers
--People whose immune systems are weakened for any reason
--Kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they could have serious reactions to the vaccine

According to Forbes Magazine, it doesn’t take much for this disease to spread through a population that isn’t immune from previous exposure or through vaccination. Or, to put it another way, in an unvaccinated population, each person infected with the measles will transmit the disease to 12 to 18 other people. However, no vaccine can protect 100% of those who receive it; vaccines can fail.

The antibodies your body creates can wane, or your body may not have sufficiently responded to the vaccine in the first place. But those who are unvaccinated are at a greater risk by far. An unvaccinated person is 35 times more likely to catch measles than a vaccinated person.

Protection against measles is delivered within the MMR (measles-mumps-rubella) vaccine. The second dose of the vaccine brings its effectiveness up to 99%. It’s a live vaccine, which ramps up the fear factor for some people, but it’s a vaccine we’ve been using since 1971. There is almost five decades of data with hundreds of millions of vaccinated individuals, and the medical community knows precisely the possible side effects of the vaccine.

The most common ones are a fever in one of six people, a mild rash in one of 20 people, and swollen glands in the cheeks or neck in one of 75 people. In one of every 3,000 doses, a child can experience a seizure caused by high fever, but febrile seizures do not cause any long-lasting damage, and they can be caused by illness (including measles) as well. A condition of low platelets, called ITP, can also occur in one out of 30,000 doses but usually goes away on its own. Any other severe occurrences that have been reported after the vaccine are, according to the CDC, “so rare that it is hard to tell whether they are caused by the vaccine.”

Measles is not a harmless childhood disease. It can kill and leave others with lifelong disabilities. Even if a person has an uncomplicated course of the disease, it’s still just a really miserable way to spend your time – a high fever, cough, sore throat and rash covering your entire body.

The problem is, there’s not much anyone can do for you when you’re sick except to help keep you hydrated. Doses of Vitamin A can reduce the severity of the symptoms, but is not a cure. More detailed information about the effects of measles on the population is available at this site: http://www.forbes.com/sites/tarahaelle/2015/01/20/five-things-to-know-about-the-disneyland-measles-outbreak/ .

So, what is the answer? Initially, and very importantly, consult your doctor if you think you or your child have contracted the disease or may be symptomatic. Secondly, get vaccinated if you can at all possible. The benefits and effects of vaccination for measles far outweigh the risks. Third, stay away from anyone who has measles. Practice smart health. It’s simply best for you and your family.

Until next time.

 

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