This is shaping up to be a banner year for a childhood disease declared eliminated from the U.S. in 2000: measles. The U.S. Centers for Disease Control and Prevention received reports of 79 cases in January, compared with 372 in all of 2018. A public health emergency has been declared in Washington state, where 52 cases had been identified by early February and the number continues to rise. Several other states are also seeing more measles than usual.
Deborah Lehman, M.D., pediatric infectious disease specialist with the David Geffen School of Medicine at UCLA, offers an update on this serious illness.
Tell me a bit about measles. I think most parents have never encountered it.
That’s absolutely right. We have a very effective vaccine against measles, so this is something our grandparents saw on a regular basis, but most of us did not see.
The tricky thing about measles is that it’s so contagious. If you just walk by someone at the grocery store or the post office or the park who has measles, without any direct contact, you can become infected.
When you have a disease that is that infectious, and you have a population that doesn’t have at least 90-95 percent vaccination coverage, then you run into a problem. It’s exactly what’s happening in Washington state. There are some communities in that state where the coverage is closer to 75 percent. The virus is smart, and it finds little pockets of the population that are vulnerable.
What is a case of measles actually like?
This is not a couple of days of fever and a little rash and then the kid goes back to school. This is a viral infection that affects the entire child with fevers up to 103 or 104 or even higher, really severe cough, runny nose, red eyes and a rash. These kids feel horrible. The first kid with measles that I saw as a trainee, I remember sitting by her bedside all night because she was so, so sick.
Children who get measles can develop viral pneumonia. That’s what accounts for most of the deaths from measles. It can also cause ear infections, a croup-like infection and, years after full recovery from measles, encephalitis, a degenerative brain disease that’s almost universally fatal.
Is there a risk that the outbreak in Washington state could spread to Southern California?
There has been measles spread from all over the country to Southern California because people get on airplanes. Certainly, people could travel from that area down to Los Angeles.
Who is at greatest risk for measles?
Anyone who has chosen not to get the vaccine, or their parents have chosen for them not to get the vaccine, or those who can’t be vaccinated because of an underlying medical condition or because they’re too young, those under a year old. Children under age 1 are also most at risk for measles-related complications.
There’s been some distrust of vaccines that may have been fueled by the fact that people don’t see measles. It’s hard to do something active against something that you don’t see as a real risk. Doctors understand that, but parents are trusting us with every other aspect of their child’s health, and I would hope that they would trust our recommendations as far as vaccines also. We’re all trying to keep children healthy.