by | Mar 13, 2024 | Family Health
Enrolling a child in school represents a huge lifestyle change. Parents suddenly must worry about school supplies and lunches, and minimizing the impact of pick up and drop off times on their workday. In Hamilton County, there is another issue for parents of immunocompromised students to consider—the growing number of school-aged children who remain unimmunized against diseases such as measles.
In 2000, after a vaccination campaign, the United States Centers for Disease Control and Prevention (CDC) declared measles eliminated, that is the virus is no longer constantly present in the country. The U.S. would lose its status if an outbreak began and continued for two years. The National Institutes of Health defines an outbreak as “an increase in the expected number of suspected measles cases being reported in a specific geographical area” reflecting a substantial rise in cases compared to non-epidemic years. From January to December of 2023 a total of 58 measles cases were reported by 20 states/jurisdictions. By February 29, 2024, the CDC reported 41 cases of measles nationwide across 16 states. In 2020, there were just 13 reported cases over 8 jurisdictions. For most, contracting measles is merely an uncomfortable situation, but for others, it can have serious and lifelong complications.
What is Measles?
Measles is a highly contagious respiratory virus that travels around in people’s noses and throats, spreads through direct contact with an infected individual, and passes from person to person via respiratory droplets created when the infected person breathes, sneezes, or coughs. The virus can live for up to two hours on surfaces and infects a person when they touch a contaminated surface and then touch their mouth, eyes, or nose. Because measles has become uncommon in the U.S. doctors and parents alike can struggle to recognize it. Despite both having the name ‘measles’ in their names, measles (rubeola) is not the same virus as German Measles (rubella).
Measles is so contagious that 90% of the unvaccinated who encounter it will become infected. There is no cure, and it must run its course. Measles is even more contagious than the flu or COVID-19, but it is incredibly preventable through vaccination. The first dose of the vaccine provides a 93% protection rate, the second dose can bring a person closer to 97%. About 1 in 100 may still contract measles, however, the case should be less severe than if they had remained unvaccinated.
Symptoms and Progression of Measles
The measles infection occurs in stages and usually clears the body within 2 to 3 weeks. A person is contagious from 4 days before they get the rash, and 4 days after they have the rash.
Incubation: For the first 10 to 14 days, and sometimes up to 21 days, the virus spreads in the body producing no signs or symptoms.
Symptoms: A mild to moderate fever is often the first sign of the virus accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis), and a sore throat. This mild illness may last 2 to 3 days.
Acute Symptoms: A rash made up of small, red, slightly raised spots appears on the face and behind the ears. The spots and bumps in tight clusters give the skin a splotchy red appearance. Over the next few days, the rash spreads down to the trunk of the body and onto the limbs while the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C).recc
Recovery: The measles rash can last up to seven days and gradually fades from the upper body and then from the lower extremities. The cough and darkening or peeling of the skin where the rash was can remain for about 10 days.
1 in 5 unvaccinated people who get measles in the U.S. are hospitalized.
How is it Spread?
Measles spreads when you interact with an infected individual by:
- Sharing food or drinks
- Kissing
- Shaking hands, holding hands, or hugging
- Touching a surface containing the virus and then touching your mouth, nose, or eyes.
Pregnant women can spread measles to their babies — either during the pregnancy, delivery, or while nursing.
Who is Most Vulnerable?
Babies, young children, pregnant women, the immunocompromised, and the unvaccinated are the most vulnerable to measles. Those of Asian descent are also more vulnerable in disproportionate numbers. You may be thinking that a fever and rash are no big deal, so why fuss about it? While having had a measles infection does provide lifelong immunity, there remain serious and unnecessary risks in contracting it.
A significant risk associated with measles infection is Subacute Sclerosing Panencephalitis (SSPE). SSPE occurs when the virus moves unknowingly to a person’s brain. In 2016 researchers revealed that 1 in 609 unvaccinated babies who contract measles are at risk of developing SSPE. The affected typically contract measles before 2 years of age and there is a 6-to-8-year latency period where the virus sits dormant with no signs or symptoms before diagnosis. Most die within 1-3 years of diagnosis. A person could be three years old, or 35 years old before they begin to experience SSPE symptoms which include cognitive and ongoing movement issues. As it progresses behavior problems develop, seizures occur, and eventually, the person becomes comatose and regresses to a vegetative state. Death is usually the result of fever, heart failure, or the brain’s inability to continue controlling the autonomic nervous system. The average age for diagnosis of SSPE is 12 years old. There remain unanswered questions about why or how the virus progresses. Currently, there is no cure for SSPE. Prevention in the form of the measles vaccination is the only real “cure” for SSPE.
According to the CDC, children younger than 5 years of age and adults older than 20 years of age are most likely to suffer from measles-related complications from common ear infections and diarrhea to more serious complications such as pneumonia and encephalitis. Unvaccinated pregnant women who get measles are at risk for preterm labor and giving birth to low birthweight babies. Health officials do not recommend vaccination for pregnant women leaving them to rely on community vaccination levels for protection.
How Does Measles Affect Children?
- 1 in 10 children develop ear infections which can bring permanent hearing loss.
- 1 in 20 children who contract measles will get pneumonia which is the number one cause of measles-related deaths.
- 1 in 1,000 children will get encephalitis (swelling of the brain) which can cause convulsions and result in intellectual disability or deafness.
- Of every 1,000 children who get measles, 2 will die from complications.
The CDC states that children with severe symptoms should receive Vitamin A to prevent a deficiency that leads to an increase in severity, prolonged recovery, and an increase in complications including blindness and even death despite the absence of known treatment for measles. In one study, two consecutive 200,000 international units (IUs) of Vitamin A over two days reduced the mortality in children aged less than two years, reduced pneumonia‐specific mortality, and reduced the incidence of croup.
How Important is Vaccination?
Due to measles’ highly contagious nature, a community’s vaccination rate can drop no lower than 95% to avoid outbreaks and protect those who are most vulnerable.
In infants, the immunity provided by their mother’s antibodies begins to wane in the first year. Vaccination is less effective in younger infants due to the lingering maternal antibodies. Occasionally, vaccination exceptions are made for babies who are over 6 months old and who have a known risk of exposure. Children receive their first dose of measles vaccine between 12 and 15 months of age.
Increasingly, U.S. parents have been seeking exemptions from state-required vaccines for their children or are delaying vaccines. Combined with the impact of the coronavirus, these trends have negatively impacted the nation’s measle infection rate over the last 20 years. In the academic years of 2019-2020 and again in 2021-2022, the national vaccination rates for kindergartners dropped to 93%, two percentage points lower than required to protect communities from outbreaks. The undesirable 93% vaccination rate translates into 250,000 kindergartners being at risk of infection. Eleven states have exemption rates that exceed 5% for kindergartners. In Idaho, the exemption rate for the measles vaccine for the 2023-2024 school year stands at nearly 20%.
Globally, the incidence of measles is on the rise. While rates may be above the 95% threshold in your community, one who has traveled to where rates are high could bring it to you. Vaccinating your child not only protects them from life-altering complications, but also serves the greater good by helping protect those who are too young or too sick for vaccination, and those who cannot receive vaccination.
If you or your family needs to update your vaccinations, visit AFC Urgent Care Ooltewah for prompt and comforting care!
