By Mary O’Brien, M.D.
Quick! What illness can cause fatal pneumonia, bacterial superinfection, meningitis, myelitis, encephalitis, acute thrombocytopenic purpura, transient hepatitis, or subacute sclerosing panencephalitis? The answer is measles. Each year nearly 20 million people are infected worldwide. There are 200,000 deaths, most of which occur in children. The anti-vaxxers are utterly unaware of these facts, but there has never been a shortage of ignorance in the world.
Measles is a highly contagious viral illness that typically strikes children. Unfortunately, more than 90 percent of susceptible people who are exposed will contract it. Measles spreads mostly by aerosolized droplets from the nose, throat, and mouth during coughing. The virus can survive airborne for two hours in closed areas like a classroom. The vast majority of measles cases in the U.S. are transmitted by travelers and immigrants, with subsequent transmission to unvaccinated children and teens.
Measles has a 7 to 14-day incubation period. The prodrome begins with fever, sneezing, watery eyes, conjunctivitis, and a hacking cough. Koplik spots develop on the oral mucosa, opposite the first and second upper molars — before the rash develops. Dental professionals take note.
A sore throat typically develops shortly before the rash, which is maculo-papular. Macules erupt just in front of and below the ears, then migrate down the sides of the neck. Papules begin to emerge as the rash spreads down to the trunk and extremities, including the palms and soles.
Peak severity is often marked by a fever above 40⁰C. Many children have periorbital edema, photophobia, irritability, pruritis, and a hacking cough. These kids look and feel very sick for 3 to 5 days, at which point the fever subsides and the rash fades and desquamates. Immunocompromised patients may be profoundly ill with severe, progressive pneumonia but no rash.
Mortality in measles is about 2 in 1000 cases in the U.S. and much higher in developing nations. In the year 2000, measles was officially declared eradicated in the U.S. by virtue of the tremendously effective MMR (measles, mumps, rubella) vaccine. Unfortunately, multiple outbreaks have recently occurred in California, Washington, Oregon, Utah, and New York. Many outbreaks have been linked to unvaccinated children in Amish and Orthodox Jewish communities. Currently, an outbreak of measles in Brooklyn, New York, has been declared. There were 285 cases, a public health emergency. Nationally, the figure stands at 465 cases documented in 15 states.
Scientific ignorance and paranoia on the part of some parents and stunning misinformation on the internet has led to clusters of unvaccinated children and rapid spread. The original “study” claiming that vaccines cause autism was entirely fraudulent. It involved 12 patients and was thoroughly debunked. The author lost his medical license. Legitimate studies of over two million children have demonstrated absolutely no relationship between vaccines and autism. Autism has been linked to over 100 genetic mutations. Many people today do not like to hear the word “genetic.”
A landmark study published several years ago in the New England Journal of Medicine revealed disrupted stratification of multiple cellular layers in the cerebral cortex early on in fetal development. The stage for autism seems to be established before birth.
Making decisions based on misguided notions and emotions can be catastrophic. Those of us in health care and education need to set the record straight.