Health Care and Measles

One of the many childhood diseases that has been largely reduced in its appearance is measles. Measles is caused by a virus and possible complications include pneumonia, according to the National Institutes of Health (NIH). Measles is a very contagious (easily spread) illness caused by a virus, and is the leading cause of death in many undeveloped countries, especially with those children with low Vitamin A deficiencies.

The infection is spread by contact with droplets from the nose, mouth, or throat of an infected person. Sneezing and coughing can put contaminated droplets into the air. Those who have had an active measles infection or who have been vaccinated against the measles have immunity to the disease. Before widespread vaccination, measles was so common during childhood that most people became sick with the disease by age 20. The number of measles cases dropped over the last several decades to almost none in the U.S. and Canada, according to the US National Library of Medicine. However, rates have started to recently rise again.

Some parents do not let their children get vaccinated because of unfounded fears that the MMR vaccine, which protects against measles, mumps, and rubella, can cause autism. Large studies of thousands of children have found no connection between this vaccine and autism. Not vaccinating children can lead to outbreaks of a measles, mumps, and rubella -- all of which are potentially serious diseases of childhood.

According to KidsHealth.org, while measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. A characteristic marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth. The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the arms and feet.

Measles are highly contagious — 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person. Measles are spread when someone comes in direct contact with infected droplets or when someone with measles sneezes or coughs and spreads virus droplets through the air. A person with measles is contagious from 1 to 2 days before symptoms start until about 4 days after the rash appears.

There are two types of measles, each caused by a different virus, according to eMedicineHealth.com. Although both produce a rash and fever, they are really different diseases:

• The rubeola virus causes "red measles," also known as "hard measles" or just "measles." Although most people recover without problems, rubeola can lead to pneumonia or inflammation of the brain (encephalitis).

• The rubella virus causes "German measles," also known as "three-day measles." This is usually a milder disease than red measles. However, this virus can cause significant birth defects if an infected pregnant woman passes the virus to her unborn child.

If people are immune to the virus (either through vaccination or by having had measles in the past), they cannot get the disease caused by that virus. For example, someone who had rubeola as a child would not be able to get the disease again. Remember that rubella and rubeola are different viruses. An infection with one of these viruses does not protect against infection with the other. Both rubella and rubeola have become so uncommon that patients normally present to their physician for a diagnosis. In general, both children and adults who have fever and a rash should contact their physician. People who have come in contact with an infected person should also be evaluated to see if they need special measures to keep them from getting sick. Normally, measles is not a disease that requires emergency care. Although there is no cure for measles, there are steps that can make the disease more tolerable. These include the following:

• Get plenty of rest.
• Sponge baths with lukewarm water may reduce discomfort due to fever.
• Drink plenty of fluids to help avoid dehydration.
• A humidifier or vaporizer may ease the cough.
• Pain relievers and fever reducers such as acetaminophen (Tylenol, Liquiprin Drops, and other brands) and ibuprofen (Advil, Motrin and other brands) can help with symptoms when used according to directions. Remember never to give aspirin to children or teenagers because it may cause a disease known as Reye syndrome.

Infants are generally protected from measles for 6 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations, according to KidsHealth.org. For most children, the measles vaccine is part of the measles-mumps-rubella immunization (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age. Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, 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. As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information regarding recommendations about the measles immunization. The measles vaccine should not be given to these at-risk groups:

• Pregnant women.
• Children with untreated tuberculosis, leukemia, or other cancers.
• People whose immune systems are suppressed for any reason.
• Kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions.

During a measles outbreak, an injection of measles antibodies called immune globulin can help protect people who have not been immunized (especially those at risk of serious infection, such as pregnant women, infants, or kids with weakened immune systems) if it's given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe. For women who are not pregnant and people not in one of the other at-risk groups mentioned above, the measles vaccine may offer some protection if given within 72 hours of measles exposure.

Kids with measles should be closely watched. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis (a serious brain infection), which may require antibiotics or hospitalization. In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years old who are hospitalized with measles and its complications. Also, all kids over 6 months old with certain risk factors — such as vitamin A deficiency, a weakened immune system, or malnutrition — might benefit from vitamin A supplementation. Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care following measles exposure, especially if your child:

• is an infant.
• is taking medicines that suppress the immune system.
• has tuberculosis, cancer, or a disease that affects the immune system.

Remember that measles, a once common childhood disease, is preventable through routine childhood immunization.

Because of widespread vaccination of children, both kinds of measles occur much less often than in the past, according to eMedicineHealth.com. Children in the United States routinely receive the measles-mumps-rubella (MMR) vaccine according to a published immunization schedule. This vaccine protects against both red measles and German measles. Vaccination (or written refusal) is required for entry into school. Doctors usually give the first dose of the measles immunization at 12-15 months of age. Doctors give a second dose of the immunization when the child is 4 to 6 years old. Although most children tolerate the vaccine well, a few may develop fever and even a rash from five to 12 days after the immunization. Adult women who get the vaccine may notice short-term aching in their joints. The vaccine is about 95% effective in preventing measles of either type. That means that a small number of people who get the vaccine may still be able to get measles. The vaccine should not be used in people with egg allergies. Rarely, the measles vaccine can cause a measles-like illness. This is most common in people with weak immune systems, such as those with advanced HIV or those on chemotherapy. In such patients, the risk of vaccination should be balanced carefully against the risk of getting measles.
Women who may become pregnant should have a blood test to be sure they are immune to rubella ("German measles").

Measles can be easily prevented, and anyone exposed to the disease should have a follow up visit to their primary care physician if symptoms start to develop. Immunization is the best way to keep measles from being contracted, and stay away from anyone who has the disease. Although usually not fatal, measles can be very uncomfortable for the duration it lasts in your system. Be wise, and be careful.

Until next time.