Measles

Measles is one of the most contagious viruses known to man.  The current 2015 outbreak which actually began in Dec 2014 at Disneyland has focused attention on this virus which had essentially been eradicated in the U.S. in 2000. The resurgence of Measles is disappointing and worrisome to health professionals who had worked so diligently to protect our children and eliminate this scourge from the population. The information below is presented  to educate our readers about measles and what to look out for. My hope is that this article and the resources it links to will also provide a rational source of basic information about vaccines to counter some of the misinformation  that unfortunately pervades the Internet.

 

Measles Virus and Illness

Measles is an airborne illness which is spread through respiratory droplets (fluids from the mouth or nose). Sneezing, coughing, or contamination of a surface with saliva or mucous are ways in which the virus can be transmitted from one person to another.  While exact information is lacking, it is believed that an infected individual is contagious 4 days before the rash develops until 4 days after it appears.

90% of unvaccinated individuals who are in close contact with an infectious measles patient will come down with the illness. IN an unvaccinated population, on average each person infected with measles will infect 12-18 other people. This compares to 2 or 3 people infected by each person who contracts the flu which makes the measles one of the most contagious illnesses known.

Symptoms include:
  • Fever
  • Cough
  • Runny nose
  • Red/watery eyes
Physical findings:
  • Two or three days after the first symptoms occur tiny white spots on the roof of the mouth known as Koplik spots may appear.
  • A rash usually develops three to five days after symptoms begin. The rash is comprised of flat red spots that begin on the face or the scalp and spread down to the neck, trunk, arms, legs, and feet.
1 in 5 people who get the measles will require hospitalization for complications. 
1 out of every 20 children with measles gets pneumonia.
1 child in every 1,000 who get measles will develop encephalitis.(This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or intellectually disabled.)

There are no antiviral agents or any other specific treatment for the measles. Only supportive treatment ( fluids, rest, fever reducers) is available so vaccination is extremely important.

Because this virus is so contagious, patients who think they have the Measles should NOT go to their doctors office. They should call their physician with their concerns first to discuss the best course of action.

The Vaccine

The Measles vaccine has been around for many years with an excellent safety record. Measles vaccine is given as a combined Measle, Mump, Rubella vaccine known as MMR. It is also one of the most effective vaccines we have. Vaccinated individuals will have a 95% reduction in the risk of contracting Measles if they are exposed. Children need two doses of the vaccine and adults need one if they have not been vaccinated in childhood or if there is evidence that their immunity has decreased below protective levels. The Measles vaccine is a live virus vaccine and not approved for use in pregnancy.

MMR Vaccine Information Sheet

Its important to have as many people vaccinated as possible so that we can develop what is often referred to as herd immunity. With herd immunity vaccinated and immune individuals provide a protective barrier between sick individuals and those who have no immunity due to illness, a suppressed immune system, or inability to be vaccinated. With very contagious viruses like Measles we need to vaccinate most of the population in order to obtain effective herd immunity.

The Controversy

The first thing to understand is that within the medical community there is virtually no controversy about vaccination. The controversy comes almost entirely from small groups of lay people and and a few hollywood celebrities who have developed a belief that vaccines are not necessary or safe.  Vaccines to some extent are a victim of their own success. Public vaccination programs have done such a good job of preventing some of these illnesses that people have forgotten how devastating a disease like polio, mumps, or measles can be and how quickly they can return if we let our guard down. When asked to vaccinate their children for a disease they have never seen, some parents have a difficult time understanding the benefits and only see imaginary risks.

Its unfortunate because there is no evidence to back up these concerns. In fact vaccines including the Measles vaccine are among the safest of all medical interventions and probably the single most important medical innovation of the past century. They are responsible for saving more lives than any other medical invention including antibiotics. So where did these ideas come from that vaccines are unsafe?

The Measles vaccine and Autism
Most of the vaccine distrust can be traced back to a 1998 study by a British surgeon named Andrew Wakefield. This was a very small study published in the British medical journal The Lancet which appeared to show a link between the Measles vaccine and Autism. This study has since been discredited and several much larger studies done since then have been unable to find any link at all.  Dr Wakefield has also been barred from practicing medicine in Britain since it was discovered that he followed unethical practices when he conducted the study.  The study has also been retracted from the Lancet due to concerns about dishonesty and the authenticity of the data. For an excellent review of this issue please watch the Kahn Academy videos below titled  "Vaccines and the autism myth - part 1 and part 2"

Too many vaccines
Some parents have raised concerns about the number of vaccines that are given. There is no evidence that the current vaccine schedule is harmful. Children are and always have been exposed to lot of viruses,bacteria, and fungi every day including thousands in our gut alone. Their immune systems have evolved to deal with exposure to many different ogranisms at one time so the theory that they can't handle exposure to two or three vaccines at a time is not based on sound science.

Spreading out the vaccines over a longer period of time may sound like a good idea on the surface but there is no evidence that spreading them out is safer. On the other hand spreading vaccines out delays the point at which a child will develop full immunity to these illnesses and increases the probability that he or she will contract a preventable disease and spread them to other vulnerable individuals.

Toxins in the vaccines
Another common argument is that vaccines contain "toxins". Toxins are the Bogey Man of individuals who seek to live a more holistic or natural life, but in fact the word has no real meaning. Oxygen and water which are essential for life are toxins under the right circumstances and Chromium which is a toxic metal is essential in small amounts to complete some important biological reactions in the body. So when we talk about whether a substance is toxic, essential, or of no consequence we can only do so if we define the amount we are talking about.

Some vaccine opponents have pointed out that certain vaccines contain trace amounts of formaldehyde. If you remember your high school biology class formaldehyde is used to preserve dead things because in high concentrations its toxic to bacteria which would otherwise decompose organs and bodies. Consuming a glass of formaldehyde would most likely be fatal, but the trace amounts found in vaccines are harmless. In fact our own bodies produce small amounts of formaldehyde as a waste product and the amount contained in a vaccine is less than the amount we ourselves make every day. Other substances found in vaccines are in such miniscule amounts that we probably get far more from our foods and from the environment every day than we do from a vaccine.
There are no substances found in vaccines that exist in levels even remotely considered toxic to human beings.

Thimerisol is another substance that some vaccine opponents raise concern about because it contains a form of mercury. Thimerisol is a preservative that is used in some vaccines in very small amounts. What vaccine opponents fail to acknowledge is that mercury exists in several forms and the type used in Thimerisol is is a form that is not toxic except  in very large quantities.  When concerns were raise about Thimerisol possibly causing Autism this theory was extensively examined. Several very large studies were done  both in the U.S. and abroad. No link was ever found but to reassure the public this substance was removed from most vaccines and in particular it was removed from all childhood vaccines. Despite this there has been no reduction in autism rates, further undermining the idea that thimerisol is a causative agent in this disorder. The MMR vaccine used today does not contain Thimerisol.

Conclusion
Arguing with the antivaccine movement has been compared to the game whack-a-mole.  As soon as one concern has been disproven or is shown to be scientifically invalid another concern is raised. Their fear of vaccines is irrational and as such its impossible to reason them out of it.  For any patient or parent who has concerns about vaccines I think the most convincing bit of evidence that these are extremely important and safe is the fact that nearly every physician vaccinates himself, his children, and his family and does so according to the recommended vaccine schedule. Just as convincing is that physicians lose money on most vaccines yet we are so sure of their importance that we are willing to absorb that loss in order to provide our patients with something so essential to their health. If you still have questions the links and videos below may help provide additional information.

Additional Reading and Viewing