Measles is nothing to sneeze at and hopefully it shouldn't be something you sneeze from today in the United States. But measles has been in the news lately. A sick passenger arriving from London to the United States and traveling through four cities eventually was diagnosed with measles. This has caused health officials to scramble trying to get in touch with passengers and staff on these flights and at these airports who came in contact with her. In a separate instance another case of an infected woman in Boston who was a French consulate worker -- this led to free mass vaccination clinics for anyone who had been to the Back Bay's Park Square building. Authorities have now identified five cases and counting.
Measles is a highly contagious serious respiratory infection. The symptoms are fever with a runny nose, watery reddish eyes and a rash of small flat red spots. The problem is, that you are the most contagious four days before the rash breaks out and initial symptoms are non-specific so risk of spreading the infection is very high. You also continue to be infectious four days after the rash appears.
That is why it is probably one of the most contagious of the childhood diseases. It spreads very easily via a cough or a sneeze. Some reports show it remains aerosolized, hanging in the air almost two hours. This accounts for why almost 90 percent of those who are susceptible and come in contact with an infectious person will come down with the disease. According to Dr. Gregory Wallace, M.D., M.S., M.P.H., medical officer in the Division of Viral Diseases at the Centers for Disease Control and Prevention (CDC), "Prior to our vaccination program basically every kid got the measles, in the pre-vaccine era in the United States while only about 500,000 cases were reported every year the actual estimated cases were about 4 million every year."
After the start of our mass vaccination program around the 1960s, the measles was declared eliminated in the Americas in about the year 2000. However because of the global society we live in today we do see sporadic cases from abroad. The CDC estimates about 10 million cases worldwide with over 164,000 deaths annually. Imported measles is not a risk for those who are vaccinated. However for those too young to be vaccinated or those who are immune compromised it is a serious problem and they have the highest risk of severe complications and death.
About one third of measles cases report one or more complication. The risk of serious complications and death are seen in children under the age of five or adults who contract the disease after the age of 20. The respiratory complications such as pneumonia account for about 60 percent of the deaths in young patients while adults usually get a serious neurological complication called encephalitis, an infection and inflammation of the brain. About one quarter of encephalitis patients are left with permanent brain damage.
The most rare, yet devastating complication of measles infection is a type of encephalitis called subacute sclerosing panencephalitis (SSPE.) According to the National Institute of Neurological Disorders and Stroke (NINDS) this deadly complication is the result of a measles virus infection while very young, usually prior to two years of age. It leads to a progressive neurological deterioration of brain function and eventual death.
There is a long latent period before symptoms appear, meaning that the neurological deterioration occurs about 7 years after the infection. It happens despite the person appearing to have recovered from the initial measles infection. According to the National Center for Biotechnology Information, because we vaccinate in the United States this complication is hardly ever seen anymore but in countries such as India they still have about 22,000 cases a year.
The initial symptoms of SSPE are very subtle and easy to miss. It can start out with just behavioral problems such as irritability, hyperactivity, memory loss and problems concentrating. These symptoms are followed by loss of motor function, problems walking and holding your head and trunk upright, as well as involuntary jerking spasms called myoclonic jerks. Eventually seizure and blindness can develop followed by a late stage coma and a persistent vegetative state. The brain's control of the autonomic nervous system, which controls involuntary functions such as heart rate and breathing, also deteriorates eventually leading to death.
No one understands this preventable tragedy better than Dr. Brian Parker and his wife Erica. They adopted their beautiful daughter Emmalee from an orphanage in India when she was two-and-a-half-years old. They were told her daughter was vaccinated for measles but after she passed away from SSPE this January at the age of eight, her doctors believed she had already contracted measles when the orphanage vaccinated her.
Erica is setting up a foundation in Emmalee's memory and making it her mission to educate people about this potential danger with foreign adoptions. She states, " It was frustrating and difficult to even find doctors who knew about SSPE, let alone could treat it." This is probably because it is so rare in the Unites States.
Most physicians practicing today went to medical school and trained after we started our mass vaccinations programs and have no experience with measles. In fact, it was a Turkish physician and leading world expert, Dr. Banu Anlar who they eventually turned to. But sadly there is no real treatment or cure for SSPE. This fatal complication usually kills its victims within one to three years after the diagnosis.
The Parker's heart-breaking story describes them helplessly watching their smiling, beautiful, energetic child who loved ballet and singing, vanish before their eyes. Unable to walk or even hold her head up before she slipped into a coma this past Thanksgiving would bring any mother to tears.
It can be even more worrisome in light of this past year's CDC report in Morbidity and Mortality Weekly. This large survey of parents found there was a statistically significant albeit small drop in the number of the children vaccinated with the combined measles-mumps-rubella vaccine (MMR) when compared to the prior year.
In a press conference about the study, Dr. Anne Schuchat M.D., Assistant Surgeon General of the United States Public Health Service and director of the National Center for Immunization and Respiratory Diseases at the CDC said, "That might be a warning sign of larger drops to come." She went on to say, even with adequate overall vaccination rates, "You can still have communities with very large pockets of susceptible children." And now the British Medical Journal has retracted and declared the 1998 Lancet study, which linked the MMR vaccine and autism, as "an elaborate fraud."
It makes one wonder, why you would even take the risk and not vaccinate your child for measles. Erica Parker told me she wants to prevent anyone else from having to go through this type of horror with his or her child. "SSPE is a tragic preventable complication you wouldn't wish on your worst enemy."