Given the recent measles outbreak, The Patient's Playbook wants to help you understand the status of the outbreak, the disease, what you can do to protect yourself and what to do if you do contract measles.
While some people may think that measles is a minor disease that may impact some children, it can actually be quite serious. Measles is a highly contagious acute respiratory illness. In severe cases, measles can lead to pneumonia, swelling of the brain, convulsions, deafness, premature births in pregnant women, and death.
United States Cases
According to the Centers for Disease Control and Prevention (CDC), 555 cases of measles have been confirmed in 20 states in 2019 (as of April 11, 2019). This is the second-highest number of cases reported in the U.S. since measles was reported to be eliminated in 2000. These outbreaks are connected to travelers who brought the disease back from other countries such as Israel, Ukraine and the Philippines and spread through communities with pockets of unvaccinated people. There are currently outbreaks (defined as three or more cases) in Washington; New Jersey; Butte County, California; Michigan; Rockland County and New York City, New York.
Number of Measles Cases by Year
Reported 2019 Measles Outbreaks
The large-scale outbreaks in New York have received much media attention. In Rockland County, there are 184 confirmed cases (as of April 12, 2019). In Brooklyn and Queens, there are 285 confirmed cases (as of April 8, 2019). On April 9, 2019, the state health commissioner ordered everyone who is unvaccinated and lives in the following zip codes to get the MMR vaccine: 11205, 11206, 11211 and 11249, or risk a $1,000 fine.
Measles is highly contagious and can be transmitted via airborne droplets when an infected person breathes, coughs and sneezes. The infectious period spans four days before and four days after the measles rash appears.
The measles virus can live for up to two hours in an airspace where an infected person has coughed or sneezed. The CDC estimates that up to 90% of the people close to an infected person will become infected if they are not vaccinated.
Symptoms generally appear about one to two weeks after a person is infected and initial symptoms may include: high fever, dry cough, runny nose, sore throat, diarrhea and red, watery eyes.
Approximately two to three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth. A rash appearing as flat or sometimes raised red spot may start to appear on the hairline of the face and spread downward to the neck, trunk, arms, legs and feet approximately three to five days after symptoms begin.
Complications may include ear infections, bronchitis, laryngitis or croup, pneumonia, encephalitis and pregnancy problems including preterm labor, low birth weight and maternal death.
If you believe that you have been exposed to someone with measles or you might have measles, we recommend that you contact your primary care physician immediately because there are things that can be done to minimize both the severity of the presentation and your symptoms, including:
If you have not been immunized, and get the vaccine within 72 hours of exposure, you may be able to mitigate the duration of the disease and severity of symptoms.
If you are a pregnant woman, have a weakened immune system, or are an infant, you can receive immune serum globulin injections within six days of exposure. This collection of antibodies can prevent the disease or result in milder symptoms.
If you have a fever, take Tylenol, Advil or other fever reducers. Do not give aspirin to children or teenagers as it has been linked to the rare but potentially life-threatening Reye’s syndrome in this population.
If you have a child with low vitamin A levels, they may be at risk of a more severe presentation. A large dose of vitamin A (as large as 200,000 international units) may be appropriate for children older than a year.
If you contract a bacterial infection like most ear infections or pneumonia, your physician may prescribe antibiotics.
People with measles should also stay home, avoid contact with other people (especially those who have not been vaccinated, are pregnant, or are at high risk), rest, drink plenty of fluids and use a humidifier for a cough and sore throat.
The long-term implications of measles can be quite serious. Measles may cause temporary "memory loss" of the immune system, which inhibits the body from remembering and responding to previously experienced diseases. it can take two to three years for the body to relearn how to effectively defend against a wide array of infectious agents. Seven to 10 years after getting measles, some patients develop subacute sclerosing panencephalitis, a rare and usually fatal central nervous system disease.
The most effective way to protect against measles is to get the measles-mumps-rubella vaccine (MMR).
The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles. Two doses are about 97% effective. Fully vaccinated people who get measles are more likely to have a milder illness and less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems.
If you get the MMR vaccine within 72 hours of being exposed to measles, you may get some protection against the disease, or have milder illness.
Vaccination Recommendations (CDC)
General Prevention Tips
If you are in an area with a documented measles outbreak, there are things that you can do to help prevent contracting the disease. This is especially important for higher risk populations, including infants and children under age five, pregnant women, the elderly and people with compromised immune systems. Here are some steps that you can take:
Try to avoid contact with people who are sick.
Wash your hands frequently with liquid soap and water for at least 20 seconds, especially after touching public installations such as handrails or door knobs and before touching the mouth, nose, or eyes.
When your hands are not visibly soiled and soap and water are not available, clean your hands with sanitizer containing at least 60% alcohol.
Consider wearing a surgical mask in public.