Since December, there have been more than 130 confirmed cases of measles in the state of California, most of them connected to an outbreak that originated in a Southern California amusement park. Many of the infected persons were not vaccinated against the extremely contagious virus, which manifests itself through rash, fever and coughing. While thought to be eradicated in the U.S., the illness has been traced to travelers who were infected in other countries. Michael Neely, MD, an infectious diseases specialist at Children's Hospital Los Angeles (CHLA), discusses how parents can prevent further outbreak, and what CHLA can do to help prevent infection and to treat those who have already been infected.
How does the measles virus spread?
MN: A person infected with the measles can spread it by direct contact or through the air by coughing or sneezing. Coughing is a typical symptom and a typical form of transmission.
How is this particular outbreak unique and newsworthy?
MN: A high number of cases are in three major Southern California counties: Los Angeles, Orange and San Diego. There are also additional cases that have spread throughout the United States, so in total we had more than 100 cases in the first month of 2015. Usually, we have about that many cases within the U.S. in the entire year. We are well on our way to the largest outbreak that we have had in years, ever since the vaccine has been introduced.
Can you describe how the anti-vaccine movement can be contributing to this outbreak?
MN: The anti-vaccine movement has led to the highest number of people who have not been vaccinated against measles since the vaccine has been introduced. So we have a larger percentage of our population now who are unfortunately susceptible to this infection. Again, because it is so infectious, it is easy for anyone who does not have immunity against this virus to become symptomatic to develop this disease when they encounter this virus.
Why is the anti-vaccine movement harmful to children?
MN: The anti-vaccine movement is incredibly dangerous to the health of children. We thought we had eradicated most these diseases, and in fact, we had. Now, we are seeing resurgence in not only measles, but also chickenpox and other vaccine-preventable illnesses. Many of the so-called evidence for this movement was based on a paper that was published many years ago that claimed to find a link between MMR vaccine and autism. Unfortunately, that paper was extremely damaging and false. The investigator who published the paper had his license stripped and he has lost repeated cases in court trying to recover that license.
Where are children potentially at risk?
MN: Children are more at risk at in areas of high density, high population. So, schools, daycare centers, amusement parks — Disneyland was the epicenter of this outbreak - are places where the illness can spread rapidly, especially during holiday time. And again, because this virus is so contagious, the contact does not have to be ongoing and sustained as you would have for some other viruses. Very casual contact like, being in the same room, breathing in the same air as an infected individual who is coughing, is enough to transmit the infection.
How long can the virus live?
MN: The usual incubation period - from the time you are exposed to the virus to the time you develop your first symptoms - generally is about a week or so. The initial symptoms that occur are usually not specific to measles so it can be a little hard to recognize that someone has measles. These symptoms can be:
•Fever
•Fatigue
•Muscle aches
•Red eye
•Runny nose
Then typically within a few days of the onset of those symptoms, you would develop a rash. It is when the rash happens is when people think this might be measles.
At what point can the virus spread?
MN: Unfortunately, an infected person can spread the virus about 4 days before the rash shows up and continue to transmit the virus until about 4 days after the rash has appeared.
What can parents do if their child has not been vaccinated yet? Are there any precautions parents should take?
MN: If you think your child has been exposed to a case of measles, we do vaccinate as young as 6 months of age. Unfortunately, the immunity that you develop when you are vaccinated before the typical age of 12 months is not as strong or durable. So it does not count in the standard series of vaccinations, which is two vaccines: one starting at about a year of age and the second at about 4 to 6 years of age.
In addition, try to avoid contact with sick people. So, even if a certain individual doesn't have measles, but has a cough, you generally want to keep your child away from this individual.
Can a child get vaccinated at any time?
MN: If your child has not been vaccinated and you wish to do so, you can always talk to your doctor. The vaccine is licensed to any patients over the age of 12 months, so that would include adolescents and adults as well.
Some children, due to their medical condition or a compromised autoimmune system, cannot be vaccinated. What should parents in that situation do then?
Children who have immunological conditions, such as cancer, cannot receive the measles vaccine, because it is a live vaccine. Parents with these children should always check with their provider or specialist on the status of whether or not they can be vaccinated. If they cannot be vaccinated, a general rule of thumb is to avoid people who are sick.
If you think your child with a compromised autoimmune system has been exposed to measles, we do have products that can be given safely, even to these children. It would consist of an immunoglobulin preparation that can be given, which provides immediate protection against developing active disease.
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