The number of measles cases linked to an outbreak in Western Texas has grown to 90, according to data released recently. 77 of the affected individuals are less than 18 years of age, with one in six requiring hospitalization. New Mexico and several other states have reported cases as well. In 2024, there were a total of 285 measles cases reported across the country, less than in 2014 but more than the 1990s and early 2000s.
What Is Measles?
Measles is a contagious viral disease also known as “rubeola.” It was once so common, it was considered a childhood rite of passage. It shouldn’t be confused with Rubella (German Measles) or Roseola, a milder viral illness also seen in childhood. The disease was almost eradicated in the U.S. in the 2000’s but has experienced a resurgence in the last few years. In long-term survival settings, we can expect it to be even more common.
Signs/Symptoms of Measles
Physicians have seen so few cases of Measles in the recent past that few doctors have ever treated a case. State health departments have had to send out flyers alerting them to the signs and symptoms of the disease.
Measles patients usually start off with a high fever, often reaching 104 degrees Fahrenheit. Two to three days later, a red patchy rash appears, usually starting on the head and face and then working its way downward. So many “spots” develop that the patches coalesce into even bigger blotches as times passes. Other symptoms often resemble respiratory and eye infections. You may see the “three C’s”:
- Cough
- Coryza (head cold symptoms like nasal congestion, etc.)
- Conjunctivits (pink eye)
Many also manifest white spots on the inside of the mouth called “Koplik’s Spots.”
Other issues that are seen in more severe cases include:
- Diarrhea (1 in 10 cases)
- Pneumonia (1 in 20 cases, the most common cause of death in children)
- Ear infections (1 in 10 cases, occasionally resulting in hearing impairment)
- Corneal scars (affecting the covering of the colored part of the eye)
- Brain inflammation and swelling (1 in 1000 cases, occasionally resulting in death or permanent damage)
- Convulsions (as a result of fever in children)
The above seems to occur more often either in children under 5 years old or adults. Pregnant women with measles may deliver prematurely or have low birth-weight infants. Death as a result of complications from measles occurs in about 1 in 1000 cases.
How Contagious Is Measles?
If you follow this blog, you may remember the “R-Nought number”(R0) I discussed during the COVID pandemic. The R-nought (or reproduction number) is the 100-year-old brainchild of a public health expert in demographics named Alfred Lotka. A disease’s R0, he said, is the number of cases that will occur in a population if an infected person is placed in the middle of it. Not just any population, however; one that hasn’t been exposed to the infection in the past.
In the 1950s, epidemiologist George MacDonald used it to describe the contagious potential of malaria. He suggested that, if the R-nought is less than 1, the infectious person will transmit to fewer than one other person and an outbreak will eventually peter out. On the other hand, if the R-Nought is greater than 1, the disease will spread. Seasonal flu carries an R-Nought of 1.28. For measles, an airborne infection, R0 is thought to be 12-18: That means each person with measles would, on average, infect 12-18 other people in a totally susceptible population.
A person with measles may transmit the disease for several days before the first symptom and continue to be contagious for several days after recovery. Treatment involves relieving symptoms like cough, nasal congestion, etc. There is no cure. The virus must run its course, which usually takes about 10 to 14 days.
Measles And Vaccination
The measles vaccine has been available since 1963 in the United States. Before vaccination became a standard recommendation, hundreds of thousands of cases and several hundred deaths were expected on a yearly basis. After its institution, the numbers of cases dropped precipitously.
Health officials have been urging anyone who isn’t vaccinated to receive the measles, mumps, rubella (MMR) combo shot. The Centers For Disease Control and Prevention (CDC) currently recommends people receive two vaccine doses, the first at ages 12 to 15 months and the second between 4 and 6 years old. One dose is 93% effective, and two doses are 97% effective against the three diseases. These protections rates are some of the best for any vaccine; only the tetanus and smallpox vaccines approach this level of success.
Concerns about vaccine safety, however, is a real issue for many Americans. For the many that are concerned, a stand-alone vaccine for measles as opposed to MMR might seem to make sense. Unfortunately (unlike some other countries), a stand-alone vaccine is not available in the United States.
Risks Of Vaccination
Many vaccines, including the one for measles, have side effects that are seen in a percentage of patients. The most common are fever, rashes, and cold-like symptoms. In the case of Measles vaccine, these occur in 5-14 cases out of 100. More serious complications are much rarer, but may include:
- Bruises
- Confusion, irritability
- Vision changes
- Swelling of glands
- Headaches
- Stiff neck
- Nausea and vomiting
- Pain, redness, or swelling at the site of injection
In normal times, anyone experiencing the above after receiving a vaccination should be evaluated by their physician, as they may be signs of a complication
The decision regarding vaccination should be based on hard data with the backing of science. Although vaccinations can have their risks, the positives far outweigh the risks when it comes to the measles vaccine. It should be noted, however, that all vaccines are not created equal; do you own research and come to the conclusion that will best protect your family.
Measles is a serious disease that is making a comeback. Be aware of the signs and symptoms and consider your strategy for dealing with any infectious disease in times of trouble.
Joe Alton MD
Dr. Alton
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