Measles Outbreak

Bindu S. Mayi, M.Sc., Ph.D.

Bindu S. Mayi, M.Sc., Ph.D., professor of microbiology at NSU’s College of Medical Sciences educates people on the measles outbreak.

You’ve probably heard about the measles outbreak that is going on in Washington (WA) state right now. As of January 27, 2019, there have been 35 cases reported, with the youngest patient being just a year old. The state of WA is now in a state of emergency, a step that Governor Jay Inslee had to take in order to deal with this highly contagious and deadly, childhood rash and fever illness.

There are a few relevant facts about measles that everyone needs to know. Measles is contagious four days before symptoms develop; this means, the infected person could be and would be out in the community, shedding viruses that can easily spread to non-immune individuals.

How does this spread happen? The act of coughing, sneezing, talking, laughing or even just breathing allows the infected person to release moist droplets carrying infectious viruses. In fact, measles has an R nought factor of 12 – 18, which means one infected individual can spread the virus to 12 – 18 individuals in a totally susceptible (vulnerable) population such as an unimmunized population. The non-immune individuals breathe in these infectious droplets and in turn, become incubators of the measles virus.

What are the symptoms that alert someone about measles? The patient develops a fever, along with cough, runny nose & congestion, conjunctivitis and a high sensitivity to light (aka photophobia). Typically, we suspect measles only when Koplik’s spots appear 2 days later. These spots look like little grains of salt that are surrounded by a red zone – they appear on the insides of the cheeks, right across from the molars. These spots are a characteristic feature of measles, and within 24 hours, are accompanied by the measles rash. At this time, the patient may also show high fever (104^ο Fahrenheit). Starting on the head, the measles rash takes one or two days to cover the entire body, including palms of the hands and soles of the feet. The rash begins as flat, red spots that may carry small, raised bumps on them. Eventually, these spots start blending together as the rash spreads through the body.

What makes measles worse? Vitamin A deficiency and malnutrition makes measles worse. In developing countries, measles kills as many as 1 out of 4 infected patients. It is also the leading cause of blindness in Africa. Measles patients also develop a generalized suppression of the immune system, which can last up to three years, leaving them vulnerable to other deadly infections.

How do you treat measles? There aren’t any antibiotics or antiviral drugs that will kill the measles virus or help you recover quickly from measles. The best treatment includes reducing fever, hydrating well, resting and administering vitamin A to patients with low levels of this vitamin. If there are secondary bacterial infections, these will need to be treated with antibiotics.

How can you protect the vulnerable in your care? Vaccination is the most effective approach. The measles component of the MMR vaccine is recommended as a two dose regimen, starting at 12 – 15 months of age, with a booster shot given at 4 – 6 years of age. The two doses result in about 97% of the vaccinees being protected against measles.

Is there mercury in the measles vaccine? No. The MMR vaccines do not contain thimerosal (which is a mercury-based preservative).

Is there any recourse for someone who is vulnerable and has already been exposed? Absolutely, yes. We can administer the measles vaccine to immunocompetent individuals within three days of knowing they have been exposed to someone with measles. As you know, this is not always easy, as individuals are contagious four days before symptoms begin. You can also administer a shot that carries pre-made antibodies against the measles virus, within six days of definite exposure to the measles virus.

How effective are these approaches? A research study done in NYC showed the vaccine to be approximately 83% effective at preventing measles when given after exposure, while the pre-made antibodies were fully protective!

Why do we want to prevent measles? Pregnant women with measles may be at an increased risk of miscarriages, premature births or low birth weight babies. Approximately 30% of infected individuals develop one or more complications such as pneumonia, ear infections and diarrhea. One in every 1,000 children who develop measles will develop encephalitis (inflammation of the brain), which can lead to deafness or intellectual and developmental disabilities. One or two in every 1,000 children with measles, will actually die from it. If death doesn’t claim an ill child, they may be at risk of a serious complication called SSPE. Short for subacute sclerosing panencephalitis, SSPE is a very rare, but fatal disease. Research studies done in the United Kingdom show that 18 out of every 100,000 patients who develop measles when they are under a year of age, and 1.1 out of every 100,000 if you are infected after five years of age, will go on to develop SSPE. The interesting thing is, symptoms of SSPE may take anywhere from one month to 27 years after measles, to develop. In another year or two post symptoms, the patient with SSPE will succumb to it – we do not have a cure for it at the moment. Although scientific literature shows us that two patients with SSPE were treated successfully in the past, we have not been able to reproduce this protocol in others and treatment is accompanied with its own undesirable side effects. So, our best approach really is to build up our herd immunity, our collective community immunity and the most effective way to do that is by adopting the MMR regimen. Another approach we can all take, and should take, is to cover our coughs and sneezes – the idea is to trap any potentially infectious droplets (dispelled by the cough and sneeze) and prevent them from infecting vulnerable individuals. One last thing that can protect us against multiple infectious agents is adequate hand hygiene – have clean hands before we touch our eyes, nose or mouth and before we eat! Saying No to infections is easy – it starts with awareness.