Measles Prevention

The Side Effects of Vaccines – How High is the Risk?

Kurzgesagt – In a Nutshell by the Bill and Melinda Gates Foundation

Hepatitis AThe United States is currently experiencing the highest number of cases of measles since the disease was declared eliminated in 2000. So far, there have over 800 cases in 22 states. However, Louisiana has not had any cases related to the current outbreak or otherwise.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others.

Healthcare professionals should call the Infectious Disease Epidemiology Section’s 24-hour line at 1-800-256-2748 as soon as a suspected case of measles is identified for immediate assistance and testing coordination with the Louisiana Public Health Laboratory.

What is Measles?

Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

A person is contagious four days before the appearance of rash and the four days after the onset of rash. The highly contagious virus spreads easily by coughing, sneezing or even being in the same room with an infected person.

Because there is no cure, treatment is geared toward alleviating symptoms. Rest, pain and fever reducers, fluids, vitamin A supplements, and the use of a humidifier are often recommended.

What are the Symptoms of Measles?

The symptoms of measles generally appear about seven to 14 days after a person is infected.

Measles typically begins with

  • high fever,
  • cough,
  • runny nose (coryza), and
  • red, watery eyes (conjunctivitis).

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

Measles Vaccination

The best protection and way to prevent measles is to have had two doses of the measles, mumps and rubella vaccine, known as MMR. Two doses are about 97 percent effective against measles. If you are unsure of your vaccination records, check with your primary-care provider. Even a single dose of MMR up to 72 hours after exposure to someone with measles can prevent it or greatly reduce symptoms.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Complications

Measles can be a serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.

Common Complications

Common measles complications include ear infections and diarrhea.

  • Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
  • Diarrhea is reported in less than one out of 10 people with measles.

Severe Complications

Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.

  • As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
  • About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.
  • For every 1,000 children who get measles, one or two will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

Long-term Complications

Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal disease of the central nervous system that results from a measles virus infection acquired earlier in life. SSPE generally develops 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness. Since measles was eliminated in 2000, SSPE is rarely reported in the United States.

Among people who contracted measles during the resurgence in the United States in 1989 to 1991, 4 to 11 out of every 100,000 were estimated to be at risk for developing SSPE. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age.

Adults and Measles

Most adults in the U.S. are at low risk for measles, and in general, do not need to be actively screened for measles in areas of the country not experiencing outbreaks if they are considered low-risk. However, there are certain adults that are considered high risk for either acquiring measles and/or transmitting the disease to other vulnerable people.

High-risk adults include:

  • Students at post-high school educational institutions
  • Healthcare personnel
  • International travelers to any country outside of the United States

High-risk adults need written documentation of two doses of the MMR vaccine, with each dose separated by at least 28 days, or other presumptive evidence of immunity. Other presumptive evidence of measles immunity includes:

  • Birth before 1957
  • Laboratory evidence of immunity
  • Laboratory confirmation of disease

Healthcare facilities should consider vaccination of healthcare personnel born before 1957 with two doses of MMR who lack laboratory evidence of immunity or laboratory confirmation of disease.

If you are a healthcare provider looking for more information on adults and measles, please click here.

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