By Dr. Joshua White
Chief Medical Officer
Muddling along in our little communities in central Vermont, it becomes easy to forget the world around us. Or, at least, easy for those of us not glued to the nonstop media cycles in today’s world, I suppose. Personally, I rather enjoy a little isolation, and I imagine most of us residing here do as well. Appreciating quiet is part and parcel to being a successful Vermonter.
Despite our backwoods environs, sometimes issues come knocking at our doors. For those unaware, New York and Washington states are currently experiencing some of the worst outbreaks of measles seen on U.S. soil in decades. As I write this, there have been well over 100 confirmed cases, with some reports approaching 200. Fortunately, it seems like our public health system is getting a handle on some of these outbreaks. Still, given that you can hop on a train in downtown Randolph and be in NYC later that day, this feels a little bit in our backyard.
Obviously the situation begs the question, “What does all of this mean to me?” To answer that requires a bit of information about measles itself.
Measles is a viral syndrome that until recently had largely been eradicated in the U.S. The disease is airborne and highly contagious, but fortunately responsive to vaccination. Around 85 percent of children worldwide have been vaccinated and this has resulted in a dramatic reduction in childhood death due to measles. In 1980, there were around 2.6 million deaths. By 2015 this was reduced to 73,000. Unfortunately, measles still affects around 20 million people a year, and more than one in 500 of these cases will die.
Measles spreads easily when an infected individual coughs or sneezes. It’s so contagious that nine out of 10 people who are not immune and share living space with an infected person will contract measles. Symptoms usually develop in one-and-a-half to two weeks after exposure. When an individual becomes ill with measles, they typically will develop a high fever (104 or greater), cough, runny nose, and impressive pink eye. Three to five days after a person becomes ill, they frequently will develop a red and flat rash that starts on the face and spreads to the rest of the body. People with measles often will be sick for a week to 10 days. It’s not unusual for measles to result in diarrhea, ear infections, and pneumonia. Less commonly, seizures, blindness, or an infection of the brain can occur.
I’ll briefly touch on vaccines, but only from the perspective of who is and who is not “safe.” The first dose of the MMR vaccine isn’t administered until a child is 12-15 months old. Full protection isn’t conveyed until the second dose, which typically occurs between ages 4 and 6. Among Gifford Pediatrics, we have a vaccination rate of 99.4 percent; this conveys what epidemiologists call “herd immunity.” What that means is that because the vast majority of the people in our area are vaccinated, everyone is protected against a measles outbreak. This includes infants not yet vaccinated, pregnant women, those with problems such as allergies to the vaccine, and those who suffer from an immune deficiency. Our protection is not perfect, and there is a slim possibility that a case of measles could pop up here. Ultimately, however, we are all relatively safe. As long as vaccination rates remain very high, our communities should continue to be safe. In New York, the outbreak has almost exclusively been restricted to the ultra-Orthodox Jewish community, which has a high rate of unvaccinated individuals. Thus, that community has no real defense against the measles outbreak they are experiencing.
So what to do, then, if you are worried that you or a loved one has measles? For starters, consider the symptoms I listed above. If there is no fever, you probably do not have measles. If there is no cough, no runny nose, no pink eye … again, probably not measles. If you visited New York City last weekend and have a fever today? Not measles (remember that you don’t get sick for a week and a half!).
AP Photo/Gillian Flaccus: A sign posted at The Vancouver Clinic in Washington warns of a measles outbreak.
Let’s imagine you or your child does have these symptoms. What to do then? First and foremost, call your pediatrician, Primary Care, or the ER! Do not just show up. Because measles is so contagious, we want to prepare for you! We often can determine how risky the situation is over the phone. If we agree that you might have measles, we will want to keep you out of waiting rooms where you might infect others. This is particularly true in the pediatric waiting rooms that often have infants who are too young for vaccinations. Don’t worry: We are more than happy to see you. We just want to protect our other patients as well!
What happens next if you are diagnosed with measles? Unfortunately, there is no specific therapy for measles. Antibiotics don’t help, as measles is a virus. If you are unfortunate enough to contract measles, your doctor will focus on treating the symptoms you already have. You may receive nausea medication, fluids, vitamins, medications to help with fever, and other supportive therapy to help you get better faster. You will also be isolated so that you don’t spread the virus to others.
Hopefully I’ve helped shed a little light on a disease that many of us had sort of forgotten existed! If you have questions or want to know more, reach out to your Primary Care provider here at Gifford. It’s our job to help you sort these things out, and we really do love doing it. We’re proud to be a part of this community and want to see all of you healthy, happy, and doing the things you love to do!
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