Category: Vaccine Preventable Diseases

What to Do If Your Child Is Exposed to Pertussis

Although things are much better than they were in the pre-vaccine era, we still have pertussis outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Pertussis?

Pertussis is very contagious, but not quite as contagious as other vaccine-preventable diseases, such as measles.

That’s why the focus on controlling pertussis outbreaks is usually looking at close contacts – those who were within about 3 feet for at least 10 hours a week or who had direct face-to-face contact with the person when they were contagious.

Have you gotten a letter from your child's school about pertussis yet?
Have you gotten a letter from your child’s school about pertussis yet?

So when you get a letter about a possible case of pertussis in your child’s school, it may be a a general warning and not that your child is at risk.

How do you get pertussis?

“Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Spread by respiratory droplets (coughing and sneezing), pertussis symptoms usually start about 5 to 10 days after being exposed to someone else who is in the early stage of their pertussis infection.

While pertussis symptoms can linger for up to 10 weeks, someone who has pertussis is most contagious during the first 2 or 3 weeks of symptoms.

Is Your Child Protected Against Pertussis?

Two pertussis vaccines, DTaP and Tdap, help protect us against pertussis.

In the Unites States, they are routinely given as a primary series (DTaP) at 2, 4, and 6, and 15 to 18 months, with a booster dose at age 4 years. And then a booster of Tdap at age 11 to 12 years. Later, Tdap is given again during each pregnancy, between 27 and 36 weeks gestation. Adults who have never had a dose of Tdap should get caught up, especially if they will be around a baby.

Protection from the pertussis vaccines wanes or wears off, so even fully vaccinated children and adults can still get pertussis. Of course, you are much more likely to get pertussis if you are unvaccinated and you will likely have more severe illness if you are unvaccinated.

Postexposure Antimicrobial Prophylaxis for Pertussis

Fortunately, as with meningitis was caused by Neisseria meningitidis and Haemophilus influenzae type b (Hib), taking antibiotics after being exposed to someone with pertussis can help prevent you from getting sick.

There are only specific situations for which this type of postexposure antimicrobial prophylaxis is recommended though, so for example, you wouldn’t usually give everyone in a school antibiotics because a few kids had pertussis.

Why not give antibiotics to everyone who might have been exposed to someone with pertussis?

“…there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.”

Postexposure Antimicrobial Prophylaxis

In addition to the fact that it likely wouldn’t stop our pertussis outbreaks, overuse of antibiotics can have consequences.

Situations in which postexposure antibiotics (azithromycin, clarithromycin, and erythromycin, or Bactrim) likely would be a good idea include:

  • household contacts of a known pertussis case
  • to help control an outbreak in a limited closed setting, like a daycare
  • contacts of a pertussis cases who are at high risk for severe pertussis, including pregnant women, infants, especially infants less than 4 months old, and people with chronic medical problems
  • contacts of a pertussis cases who are also contacts of someone who is at high risk for severe pertussis

What if you were exposed to someone with pertussis and have already gotten sick?

If your child was exposed to pertussis and is now coughing, then in addition to antibiotics, pertussis PCR testing and/or culture will also likely be done to confirm that they have pertussis. And remember that their contacts might need postexposure antibiotics.

Kids who have been exposed to pertussis and who have been coughing for more than 3 weeks won’t need antibiotics or testing, as it is too late for the antibiotics to be helpful and likely too late for testing to be accurate. Fortunately, after 3 weeks, they should no longer be contagious.

What to Do If Your Unvaccinated Child Is Exposed to Pertussis

Unvaccinated kids who are exposed to pertussis should follow the postexposure antimicrobial prophylaxis guidelines.

They should also get caught up on their immunizations, including DTaP if they are between 2 months and 6 years, or Tdap if they are older.

What to Do If Your Vaccinated Child Is Exposed to Pertussis

Since protection from the pertussis vaccines wanes, even kids who are fully vaccinated should follow the postexposure antimicrobial prophylaxis guidelines if they are exposed to pertussis.

Then why get vaccinated?

Again, being vaccinated, your child will be much less likely to get pertussis than someone who is unvaccinated. Even though the pertussis vaccine isn’t perfect, it has been shown that children who had never received any doses of DTaP (unvaccinated children) faced odds of having pertussis at least eight times higher than children who received all five doses.

What to Know About Getting Exposed to Pertussis

Talk to your pediatrician if your child gets exposed to pertussis to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Pertussis

When Was the Last Measles Death in the United States?

How many measles deaths have there been in the United States in the past ten years? Dr. Bob Sears frequently says that there have been none. It is easy to see that Dr. Bob is wrong, not even counting the latest death in 2015.

Measles Deaths in the United States

Measles deaths are thought to occur in about 1 in every 500 to 1,000 reported cases. This is not just in developing countries or in people with chronic medical conditions.

Consider that in an outbreak in the United States from 1989 to 1991, amid 55,622 cases, there were 123 deaths.

More recently, measles cases and measles deaths in the United States include:

  • 2000 – 86 cases – 1 measles death (infant)  – endemic spread of measles eliminated in U.S.
  • 2001 – 116 cases – 1 measles death
  • 2002 – 44 cases
  • 2003 – 55 cases – 1 measles death (1 year old)
  • 2004 – 37 cases – record low number of measles cases
  • 2005 – 66 cases – 1 measles death (1 year old)
  • 2006 – 55 cases
  • 2007 – 43 cases
  • 2008 – 140 cases
  • 2009 – 71 cases – 2 measles deaths
  • 2010 – 63 cases – 2 measles deaths
  • 2011 – 220 cases
  • 2012 – 55 cases – 2 measles deaths
  • 2013 – 187 cases (large outbreak in New York City – 58 cases)
  • 2014 – 667 cases (the worst year for measles since 1994, including the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio)
  • 2015 – 188 cases – got off to a strong start with a big outbreak in California – 1 measles death
  • 2016 – 86 cases
  • 2017 – 118 cases

So that’s 11 measles deaths since 2000 and at least 8 measles deaths since 2005.

Why do people say that there have been no measles deaths in the United States in the past 10 years? Whether they are misinformed or intentionally trying to misinform people, they are wrong.

The Last Verifiable Measles Death in the United States

The CDC is actually contributing a bit to the confusion over measles deaths, in that when asked, they have  said that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths.”

They explain the discrepancy between that statement and other CDC reports, like the recently published “Summary of Notifiable Diseases — United States, 2012,” which clearly documents measles deaths in 2005, 2009, and 2010, by saying that those reports are based on “statistical information about deaths in the United States.”

But that statistical information comes from death certificates that are sent in from all over the United States to the National Vital Statistics System. The system isn’t like VAERS, where just anyone can send in a report. You don’t necessarily have to be a doctor to sign and file a death certificate though either, which is why the CDC is probably hung up on saying that the last verifiable measles deaths were in 2003.

To be more precise when talking about measles deaths in the United States, since it doesn’t seem like the CDC has verified each and every measles death after 2003, it is likely best to say that death certificates have been filed in 2005, 2009 (2), 2010 (2), and 2012 (2) that listed measles as a cause of death code.

Of course, that still means that there have been measles deaths in the United States since 2003.

SSPE – More Measles Deaths

Lately, in addition to deaths from acute measles infections, there have been even more deaths from subacute sclerosing panencephalitis (SSPE).

About 6 to 8 years after having measles, children with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures. As symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state.

Children with SSPE usually die within 1 to 3 years of first developing symptoms, including in the United States:

  • 2000 – 5 SSPE deaths
  • 2001 – 2 SSPE deaths
  • 2002 – 5 SSPE deaths
  • 2003 – 0
  • 2004 – 1 SSPE death
  • 2005 – 2 SSPE deaths
  • 2006 – 3 SSPE deaths
  • 2007 – 3 SSPE deaths
  • 2008 – 3 SSPE deaths
  • 2009 – 2 SSPE deaths
  • 2010 – 0
  • 2011 – 4 SSPE deaths
  • 2012 – 1 SSPE death
  • 2013 – 1 SSPE death
  • 2014 – 0
  • 2015 – 0
  • 2016 – 0
  • 2017 – 0

That’s 32 SSPE deaths since 2000 and at least 19 SSPE deaths since 2005. Why so many? Many of them can likely be attributed to the large number of cases associated with measles outbreaks from 1989 to 1991.

Fortunately, as the number of measles cases has been dropping in the post-vaccine era, so have the number of SSPE deaths.

The National Registry for SSPE, reported that there were at least 453 cases between 1960 and 1976. There were 225 deaths from SSPE between 1979 and 1998. The registry wasn’t established until 1969 though, and it is now becoming clear that the risk of developing SSPE is much higher than once thought.

A recent study of measles in Germany has found that the risk of developing SSPE is about 1 in 1,700 to 1 in 3,300 cases of measles.

Other Myths About Measles Deaths

One of the classic measles myths we hear is that measles was disappearing even before the measles vaccine was developed. It is true that measles deaths had been dropping since the turn of the century.

The measles death rate (deaths per 100,000 people) in the United States was:

  • 1900 – 13.3 (about 7000 deaths)
  • 1910 – 12.4
  • 1920 – 8.8
  • 1930 – 3.2
  • 1935 – 3.1
  • 1940 – 0.5
  • 1945 – 0.2
  • 1950 – 0.3 (468 deaths)
  • 1955 – 0.2 (345 deaths)
  • 1960 – 0.2 (380 deaths)
  • 1963 – first measles vaccine licensed
  • 1965 – 0.1 (276 deaths)
  • 1970 – 0.0 (89 deaths)
  • 1975 – 0.0 (20 deaths)
  • 1980 – 0.0 (11 deaths)
  • 1985 – 0.0 (4 deaths)

That’s not surprising though. The general death rate had dropped from 17.8 in 1900 to 7.6 in 1960. For infants under age 12 months, the death rate dropped from 162.4 in 1933 to 27 in 1960.

This simply reflects that vaccines were not the only medical technology that helped to save lives in the 20th century and not that measles was already disappearing. Penicillin, insulin, vitamin D, blood typing (allows transfusions of blood that has been typed and cross-matched), dialysis machines, and mechanical ventilators were all discovered in the early 1900s.

anti-vax-measles-graph
Despite how anti-vaccine charts try and mislead you, measles was still very deadly when the first measles vaccines were introduced.

If you notice though, the death rate for measles got stuck after the 1940s at about 0.2 to 0.3, even as modern medicine continued to advance. That’s about 300 to 500 measles deaths each year in the United States. This was after World War II and through the 1950s and early 1960s, hardly a time of poor hygiene or poor nutrition or when Americans were without access to medical care.

It took about 20 years for those deaths to start dropping again, and it took the coming of the measles vaccine to do it.

So if we stop vaccinating, we won’t get to 7,000 measles deaths a year again in the United States. Modern medicine has improved a great deal since 1900. We would eventually get to about 320 to 960 measles deaths a year though (using our current population of 320 million people and a measles death rate between 0.1 and 0.3).

Other Facts About Measles Deaths

People still die of measles.

What else do you need to know about measles deaths?

  • SSPE is caused by wild type measles. Vaccine strain measles has never been found in the brain tissue of anyone who has ever died of SSPE.
  • Although SSPE was first described by Dr. James R. Dawson, JR as a new type of epidemic encephalitis in 1933 (Dawson’s disease), that it is a late complication of a natural measles infection wasn’t discovered until much later.
  • People have recently died of measles in other industrial countries too. Basically anywhere there have been measles outbreaks, there have been measles deaths, including Canada, Japan, Germany, the Netherlands, the UK, and France, etc.
  • Worldwide, about 400 people die each and every day from measles.

The latest measles deaths we have been hearing about?

Dozens of infants, children, and adults, almost all unvaccinated have died in large outbreaks since the beginning of 2016 in Europe.

What To Know about Measles Deaths

Measles is still deadly, even in this era of modern medicine, sanitation and good nutrition.

More on Measles Deaths

A History of Measles Outbreaks in United States

We have come a long way since the development of the first measles vaccines in the early 1960s…

Pre-Vaccine Era Measles Outbreaks

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are quarantined for at least 21 days.

In the pre-vaccine era, measles was a very common childhood disease.

As it is now, it was also a deadly disease.

In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).

In 1962, there were 469,924 cases of measles in the United States and 432 deaths.

Post-Vaccine Era Measles Outbreaks

The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.

In 1970, there were only 47,351 cases and 89 deaths.

Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.

Post-Elimination Era Measles Outbreaks

Measles cases usually begin increasing in April and May. How many cases will we see this year?
Measles cases usually begin increasing in April and May. How many cases will we see this year?

Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, all of the latest measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.

We have seen more than a few records in the post-elimination era, including:

  • the year with the historic low number of measles cases – 37 cases in 2004
  • the year with the largest number of cases since 1994 – 667 cases in 2014
  • the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014

In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.

2017 Measles Outbreaks

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.

The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.

And it went on, with other measles cases in 2017 including:

  • at least 122 cases
  • cases in 16 states, including California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington
  • an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
  • one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
  • four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
  • a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
  • an infant in Suffolk County, New York who had been overseas
  • an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
  • two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
  • two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
  • a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
  • a young child in Macomb Count, Michigan who required hospitalized and has been linked to international travel
  • a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks
  • an unvaccinated student at Laguna Beach High in Orange County, California, which led to the quarantine of at least 6 unvaccinated students
  • a staff member at Discovery Academy of Lake Alfred in Florida
  • an unconfirmed case in an infant who attended the College of Staten Island Children’s Center in New York
  • two children in Minnesota without a known source of infection
  • another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
  • five more unvaccinated children in Minnesota, as the outbreak grows to 8.
  • a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
  • a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
  • another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
  • three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
  • four possible cases in Nebraska
  • eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
  • four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
  • five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
  • three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
  • more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
  • a teen visiting the United States from India who developed measles and exposed others at a hotel and a hospital in Bergen County, New Jersey and in upstate New York.
  • a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
  • more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
  • a case in Pennsylvania who exposed others at a visitor center
  • someone who visited the MIT Museum in Cambridge, Massachusetts.
  • two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
  • one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
  • a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
  • someone in Franklin County, Maine (their first case in Maine in 20 years!) who traveled out of the country and caught measles, returning home and possibly exposing others at a movie theater, restaurant, farmers market, and hospital.
  • A case in Butler County, Kansas. Many remember that one of the largest outbreaks of 2014 was in Kansas.
  • an unvaccinated man who lives in Hennepin County, raising the number of cases in this ongoing outbreak (an outbreak that has already cost over $500,000 to contain and which many hoped would soon be over) that started in March to at least 79 cases. With the new case, the clock starts ticking again and Minnesota will have to wait to see if new cases appear over the next 3 weeks.
  • passengers from 13 states on an American Airlines flight from New York to Chicago were exposed to a person with measles in early July, including a 12-week-old infant who required preventative treatment with immune globulin (IG), as she was too young to be vaccinated.
  • a fully vaccinated resident of Onondaga County, New York who was exposed on a domestic flight, only developed mild symptoms, but did expose others.
  • someone who exposed others at the Penn State University Hetzel Union Building Bookstore and other places in State College, Pennsylvania.
  • a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days.
  • a possible case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment.
  • a traveler who spent time in Hampton Beach in New Hampshire, exposing others.
  • a 46-year-old male in Ohio that got the disease while traveling internationally.

2017 would have been a mild year for measles, except for the really big outbreak in Minnesota… 79 people got measles, 71 were unvaccinated, more than 500 people were quarantines, and the outbreak cost over $1.3 million to contain.

2016 Measles Outbreaks

Starting slow, 2016 ended as a fairly average year for measles:

  • 83 cases
  • cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
  • a large outbreak in Arizona, 23 cases, linked to a private detention center
  • a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
  • an ongoing measles outbreak in Los Angeles County and Santa Barbara County that has been linked to the Los Angeles Orthodox Jewish community
  • a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department

As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.

2015 Measles Outbreaks

With a large outbreak in California, 2015 got off to a very strong start.

Most concerning, more and more, cases don’t seem to have an source that is easy to find, which could mean that the endemic spread of measles has returned in the United States. So instead of having to travel out of the country or be exposed to someone who got measles with a link to international travel, you could get measles just by going to a ball game, a movie theater, or to Disneyland. That makes it more important than ever to learn how to avoid measles.

Among the 189 measles cases and outbreaks in 2015 were:

  • 113 cases that were associated with a multi-state outbreak that was linked to Disneyland in California. Before it was declared over on April 17, a few unvaccinated travelers also help spread measles from this outbreak to large outbreak in Quebec, Canada. All in all, the outbreak was linked to at least 113 cases in California and an additional 169 cases in Arizona (5), Nebraska (1), Utah (3), Colorado (1), Washington (2), Oregon (1), Mexico (1), and Canada (155).
  • 13 cases, including an adult worker and 12 infants too young to be vaccinated at the KinderCare Learning Center in Illinois.
  • At least 13 cases, all intentionally unvaccinated, in a South Dakota outbreak that started with an unvaccinated adult traveling to India.
  • Five cases in Clallam County, Washington, including four who were not vaccinated, which cost at least $36,000 to contain and led to the death of an immunosuppressed woman.

In addition to these large outbreaks, 2015 also saw a number of quarantines for unvaccinated students, closing of daycare centers, and a recommendation from a California Department of Health state epidemiologist that people who are not vaccinated against measles “avoid visiting Disney” and “crowded places with a high concentration of international travelers, such as airports.”

Other measles cases in 2015 include:

  • A student at UC Berkeley who may have exposed others to measles on a public bus.
  • A confirmed case in Fairbanks, Alaska – their first case in 15 years, who flew in from Seattle (and is probably the King County case discussed below) and may have exposed others at an area Walmart, Home Depot, Walgreens, several supermarkets, the airport, and hospital, etc.
  • A confirmed case in King County, Washington, who may have exposed others in Seattle, including at an area McDonalds, the Baroness Hotel, a drug store, and the Sea-Tac Airport.
  • A confirmed case in Branson, Missouri, a traveler from Asia, who was contagious when visiting the ER, three local businesses, and perhaps his flight to town.
  • A confirmed case in the Washington D.C. area.
  • Another case of measles in Spokane County, Washington – an unvaccinated person that was exposed to the other case in the area.
  • An unvaccinated student from Europe in Boston, Massachusetts who also traveled to Maine and New Hampshire.
  • Another unvaccinated child in St. Lucie County, Florida – bringing the total to five cases in central Florida in what so far looks like two separate outbreaks.
  • Another case in Indian River County, Florida – an unvaccinated child.
  • An unvaccinated adult in Spokane, Washington – the first case in the area since 1994.
  • Two unvaccinated adults in Indian River County, Florida, one of whom contracted measles while traveling out of the country.
  • An unvaccinated 6-year-old in St. Lucie County, Florida who attended Fairlawn Elementary School in Fort Pierce – leading to five unvaccinated students being kept out of school until early May.
  • The first case in Oklahoma since 1997, a case in Stillwater.
  • A case in Florida, a traveler who was contagious while attending a conference at the Gaylord Palms Resort and Convention Center and also in Maimi-Dade, Orange, and Sarasota counties.
  • A new case in Illinois, the 15th – and so far not linked to the other two outbreaks in the state.
  • A student at Princeton University in New Jersey.
  • Another case of measles in the Washington D.C. area, a case without a known source.
  • A case in a student at Elgin Community College in Kane County, Illinois.
  • A hospitalized infant in Atlanta, Georgia.
  • An unvaccinated 1 year old in Jersey City, New Jersey.
  • A traveler in King County, Washington that may have exposed others in Seattle. The unvaccinated visitor is from Brazil, where there was a large outbreak of measles last year (almost 400 cases).
  • At least one more case in Clark County, Nevada and four more possible cases in Southern and Northern Nevada, which led to the quarantine of at least 11 students at the Spanish Springs Elementary School.
  • A case in Franklin County, Pennsylvania.
  • Four cases of measles in travelers, including two international travelers, who visited Florida.
  • A case in Washington D.C.
  • A student at Bard College in Dutchess County, New York, who exposed many people while traveling on an Amtrak train to Penn Station in New York City.
  • An unvaccinated woman in New Castle County, Delaware who had recently traveled out of the country.
  • A case on the University of Minnesota Twin Cities campus in a student that had recently returned from out of the country. Although others were exposed, it is considered to be a “highly immunized” population, so hopefully the outbreak won’t spread.
  • Two more cases in Arizona that are tied to the Disneyland outbreak, including a woman in Phoenix who may have exposed others up to 195 children at the Phoenix Children’s East Valley Center, including a 3-year-old getting chemotherapy for leukemia.
  • An adult in Cook County, Illinois which in not linked to Disneyland.
  • A student at Valley High School in Las Vegas which led to the quarantine of 36 unvaccinated students until early February.
  • Four cases among an unvaccinated family in Kearny, Arizona that is directly linked to the Disneyland outbreak.
  • A child in Sioux Falls, South Dakota that is unrelated to 13 recent cases in the area and which has no link to travel out of the area.
  • A new case in Oakland County, Michigan that is likely linked to the Disneyland measles outbreak, meaning that the outbreak has now spread to include 7 states and 2 countries.
  • A case in Maricopa County, Arizona has been linked to the Disneyland outbreak.
  • A person in Nebraska who could have exposed others in Omaha and Blair, including at the Omaha Children’s Museum.
  • A case in Lane County, Oregon that has been linked to the Disneyland measles outbreak.
  • A resident of Tarrant County in North Texas who developed measles after a trip to India.
  • Another unvaccinated person in Utah with links to the Disneyland outbreak has tested positive for measles, bringing the total in that state to 3 cases.

In addition to the 36 measles cases that have been associated with the Disneyland outbreak, California already has 5 additional measles cases this year with no link to Disney, including cases in Alameda, Orange, and Ventura Counties.

 

For More Information On Measles Outbreaks:

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What to Do If Your Child Is Exposed to Rabies

Do kids still get rabies?

Tragically, most folks know that they do because of the story of the unvaccinated 6-year-old boy in Florida who died after being exposed to a rapid bat earlier this year.

Getting Exposed to Rabies

Rabies is a vaccine-preventable disease.

Unlike most other vaccine-preventable diseases though, unless you are at high risk for getting rabies, you don’t typically get the rabies vaccine unless you have already been exposed to rabies.

How does one get exposed to rabies?

Now that most people get their pets vaccinated against rabies, these exposures typically come from wild animals, including:

  • raccoons
  • skunks
  • foxes
  • coyotes
  • bats

While any mammal can be susceptible to rabies, small mammals, including squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits, and hares, rarely get rabies and aren’t usually thought to be a risk for humans.

Your other pets, including dogs, cats, and ferrets, are though. They should be vaccinated against rabies. As should other domestic animals, including cows, goats, sheep, and horses.

To avoid rabies, teach your kids to avoid wild animals.
To avoid rabies, teach your kids to avoid wild animals. Photo by Emilie Chen (CC BY-ND 2.0)

It is also important to teach your kids to avoid wild animals. While most kids won’t go out of their way to pet a coyote, they might try to feed a racoon or skunk, and they might pick up a bat they find on the ground.

Kids should also avoid cats and dogs that they don’t know. Your kids should not just walk up and pet unfamiliar dogs and cats.

What to Do If Your Child Is Exposed to Rabies

Unfortunately, you won’t always know if an animal has rabies, although an animal acting strangely can be a tip off that they might have rabies.

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

That bat your kids found on the ground could definitely have rabies, especially if they found it during the day. And the bat doesn’t even have to obviously bite your child. For example, if you find a sick or dead bat in your child’s room in the morning when he wakes up, you should consider that a possible exposure to rabies.

Many other exposures happen when kids are bitten by stray cats or dogs.

What do you do?

According to the CDC, if your child is bitten by any animal or has any possible exposure to rabies, you should:

  • immediately wash the wound well with soap and water, also using a povidone-iodine solution (Betadine Antiseptic Solution) to irrigate the wound if it is available
  • see a healthcare provider
  • call your local animal control for help in capturing the animal for observation or rabies testing

Animal control can also help in verifying a pet’s rabies vaccination status if your child was bitten by a neighborhood cat or dog.

“A healthy domestic dog, cat, or ferret that bites a person should be confined and observed for 10 days. Those that remain alive and healthy 10 days after a bite would not have been shedding rabies virus in their saliva and would not have been infectious at the time of the bite.”

CDC on Human Rabies Prevention — United States, 2008

In general, unless they already appear rabid, dogs, cats, and ferrets can be quarantined and observed for 10 days to see if they develop signs of rabies before your child begins post-exposure prophylaxis.

Other animals, including skunks, raccoons, foxes, coyotes, and bats should be considered rabid, with a quick start of post-exposure prophylaxis, unless the animal can be quickly tested (brain material) for rabies. And of course, you would be more considered about rabies if the animal was acting strangely, looked sick, or if it was an unprovoked attack.

What if you can’t find or capture the animal?

Depending on the circumstances, your pediatrician, with the help of your local or state health department, can determine if your child needs rabies post-exposure prophylaxis with rabies immune globulin and a 4 dose series of the rabies vaccine over 2 weeks.

“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”

CDC on Rabies in the U.S.

About 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year. That works to keep the number of rabies cases and rabies deaths in people very low.

And it is not probably not at the top of your list of things to think about at a time like this, but animal bites can also be a risk for tetanus. Make sure your child doesn’t need a tetanus shot.

What to Know About Getting Exposed to Rabies

Keep your kids safe from rabies by vaccinating your pets and teaching them to avoid wild animals, but also know what to do if your child is exposed to rabies.

More on Getting Exposed to Rabies

What to Do If Your Child Is Exposed to Meningitis

Meningitis is classically defined as an inflammation of the membranes that cover the brain and spinal cord, and it can be caused by:

  • viruses – also called aseptic meningitis, it can be caused by enteroviruses, measles, mumps, and herpes, etc.
  • bacteria – Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae type b (Hib), Group B strep
  • a fungus – Cryptococcus, Histoplasma
  • parasites – uncommon
  • amebas – Naegleria fowleri

Surprisingly, there are even non-infectious causes of meningitis. These might be include side-effects of a medication or that the child’s meningitis is a part of another systemic illness.

What to Do If Your Child Is Exposed to Meningitis

While meningitis can be contagious, it greatly depends on the type of meningitis to which they are exposed as to whether or not your child is at any risk.

Teens and young adults need two different kinds of meningococcal vaccines to get full protection.
Teens and young adults need two different kinds of meningococcal vaccines to get full protection.

So while the general advice is to “tell your doctor if you think you have been exposed to someone with meningitis,” you should try and gather as much information as you can about the exposure.

This information will hopefully include the type of meningitis they were exposed to, specifically if it was bacterial or viral, the exact organism if it has been identified, and how close of an exposure it was – were they simply in the same school or actually sitting next to each other in the same room.

For example, while the CDC states that “people who are close contacts of a person with meningococcal or Haemophilus influenzae type b (Hib) meningitis are at increased risk of getting infected and may need preventive antibiotics,” they also state that “close contacts of a person with meningitis caused by other bacteria, such as Streptococcus pneumoniae, do not need antibiotics.”

And you often don’t need to take any preventive measures if you are exposed to someone with viral meningitis.

While that might sound scary, it is basically because you typically aren’t at big risk after this kind of exposure. You could get the same virus, but the chances that it would spread and also cause meningitis are very unlikely.

Not only does Viera Scheibner think that vaccines cause SIDS and shaken baby syndrome, she thinks they are contaminated with amoeba.
The Naegleria fowleri ameba that can cause meningitis can be found in warm freshwater, including lakes and rivers.

Other types of meningitis, like primary amebic meningoencephalitis (PAM) and fungal and parasitic meningitis aren’t even contagious.

The Histoplasma fungus spreads from bird or bat droppings, for example, not from one person to another.

And parasites typically spread from ingesting raw or undercooked food, or in the case of Baylisascaris procyonis, from ingesting something contaminated with infectious parasite eggs in raccoon feces.

What to Do If Your Unvaccinated Child Is Exposed to Meningitis

Vaccines can prevent a number of different types of meningitis.

From Hib and Prevnar to MMR and the meningococcal vaccines, our children routinely get several vaccines to prevent meningitis.

While these meningitis vaccines don’t protect us from all of the different types of viruses, bacteria, and other organisms that can cause meningitis, they do prevent many of the most common.

So what do you do if your unvaccinated child is exposed to meningitis?

You should immediately call your pediatrician or local healthy department, because they might need:

  • antibiotics (usually rifampin, ciprofloxacin, or ceftriaxone) if the meningitis was caused by Neisseria meningitidis
  • antibiotics (rifampin) if the meningitis was caused by Haemophilus influenzae type b (Hib)

The availability of these antibiotics isn’t a good reason to skip or delay getting vaccinated though, as you won’t always know when your kids have been exposed to meningitis and not all types of vaccine-preventable meningitis can be prevented with antibiotics.

Of course, getting fully vaccinated on time is the best way to prevent many of these types of meningitis and other life-threatening diseases.

What to Do If Your Vaccinated Child Is Exposed to Meningitis

Even if your child is vaccinated, they might still need preventative antibiotics if they are exposed to someone with Hib or meningococcal meningitis, as vaccines are not 100% effective.

“Regardless of immunization status, close contacts of all people with invasive meningococcal disease , whether endemic or in an outbreak situation, are at high risk of infection and should receive chemoprophylaxis.”

AAP Red Book on Meningococcal Infections

This is especially true if they are not fully vaccinated.

Remember, to be fully vaccinated against Haemophilus influenzae type b, kids get a 2 or 3 dose primary series of the Hib vaccine when they are infants and a booster dose once they are 12 months old.

In the case of exposure to Hib meningitis, antibiotic prophylaxis would be recommended if:

  • the child is fully vaccinated, but there is a young child, under age 4 years, in the house who is unvaccinated or only partially vaccinated
  • the child is fully vaccinated, but there is another child in the house who is immunocompromised
  • the child is only partially vaccinated and under age 4 years
  • there is an outbreak in a preschool or daycare, with 2 or more cases within 60 days

And anyone exposed to someone with meningococcal meningitis should likely get antibiotics (chemoprophylaxis), even if they are fully vaccinated.

Talk to your pediatrician or local health department if your child is exposed to meningitis and you aren’t sure what to do, whether or not your child has been vaccinated.

What to Know About Getting Exposed to Meningitis

Learn what to do if your child is exposed to someone with meningitis, especially if they are unvaccinated, or have been exposed to someone with Hib meningitis or meningococcal disease.

More on Getting Exposed to Meningitis

What to Do If Your Child Is Exposed to Hepatitis A

Hepatitis A is a vaccine preventable disease.

The hepatitis A vaccine was first added to the immunization schedule in 1996, but wasn’t made a universal recommendation for all children until 2006. At first, it was just given to high risk kids.

Now all toddlers begin to get a two dose hepatitis A vaccine series beginning when they are 1 to 2 years old, with 6 to 18 months between the doses.

Unfortunately, unlike many other vaccines, there was never a catch-up plan for those who were unvaccinated, so some teens and many adults are still not vaccinated and still not protected against hepatitis A infections.

Getting Exposed to Hepatitis A

How do you get hepatitis A?

“The hepatitis A virus is able to survive outside the body for months. High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F (85°C), kill the virus, although freezing temperatures do not.”

CDC on Hepatitis A Questions and Answers

Unlike hepatitis B, which is spread through blood and body fluids, people who are infected with hepatitis A shed the virus in their stool.

So you can get infected by having close contact with someone who has hepatitis A or by eating or drinking contaminated food or water.

How do you know if you have been exposed?

While an employee in the produce department at a Kroger in Kentucky recently exposed folks to hepatitis A, back in 2016 it was a Whole Foods in Michigan that was linked to an outbreak.
While an employee in the produce department at a Kroger in Kentucky recently exposed folks to hepatitis A, back in 2016 it was a Whole Foods in Michigan that was linked to an outbreak.

Exposures are most common in local common-source outbreaks caused by sick food handlers at restaurants and grocery stores and multi-state hepatitis A outbreaks caused by contaminated foods. These types of exposures are usually announced by your local or state health department.

Other exposures occur if you are living with someone who develops hepatitis A or travel to a country where hepatitis A is still common.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis A

If your unvaccinated child is exposed to hepatitis A, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and not longer than 14 days, including either:

  • the first dose of hepatitis A vaccine, with plans to get the second dose of vaccine in 6 months, or
  • a dose of immune globulin (provides a passive transfer of antibodies)

In general, getting the hepatitis A vaccine is preferred over getting immune globulin for most healthy people between 12 months and 40 years of age. For infants less than 12 months (too young to be vaccinated) and unvaccinated adults over age 40 years, immune globulin is preferred after an exposure to hepatitis A.

Immune globulin is also preferred for anyone who is immunocompromised or chronic liver disease.

What if it has been more than 14 days since the exposure?

While it is likely too late for immune globulin, your unvaccinated child should still likely get a dose of hepatitis A vaccine to protect against future exposures. And watch carefully over the next 15 to 50 days (the incubation period) for symptoms of hepatitis A, which can include jaundice, fever, and vomiting, etc. Many children don’t have symptoms though, so your child could develop hepatitis A, and be contagious and expose others without your even knowing it.

If post-exposure vaccination works, can’t you just wait until your child is exposed to get vaccinated? That might work – if you could be sure about each and every exposure that your child will ever have. Since that’s not possible, don’t delay getting vaccinated and put your child at risk of getting hepatitis A.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis A

The hepatitis A vaccine is very effective.

One dose provide 95% protection against hepatitis A infections and the second dose boosts the efficacy rate up to 99%.

If your child is partially vaccinated, with just one dose and has been exposed to hepatitis A, get the second dose if it has been at least six months since he was vaccinated. Otherwise, talk to your pediatrician or local health department, but your child is likely considered protected.

What to Know About Getting Exposed to Hepatitis A

Learn what to do if your child is exposed to hepatitis A, especially if they aren’t already vaccinated and protected.

More on Getting Exposed to Hepatitis A

What to Do If Your Child Is Exposed to the Flu

During a bad flu season, especially when effectiveness of the flu vaccine is less than ideal, parents want to know how to protect their kids from the flu.

Protecting Kids from the Flu

Cover your coughs and sneezes so you don't spread the flu virus to other people.
Covering your coughs and sneezes might help prevent the spread of the flu virus to other people.

Of course,  the best way to protect kids from the flu and serious complications of the flu is to get a flu vaccine each year.

Still, the flu vaccine isn’t perfect.

So, what else can you do?

Like other respiratory diseases that are mainly spread by coughing and sneezing, you can help reduce the risk that your kids will get sick by:

  • as much as possible and practical, keeping your kids away from other people, especially those who are obviously sick
  • encouraging your kids and others to properly cover their coughs and sneezes
  • teaching your kids to wash their hands properly
  • encouraging your kids to not touch their eyes, nose, or mouth, or to bite their nails or put things in their mouth, like their pencil or pen
  • cleaning and disinfecting surfaces that your child will likely touch
  • encouraging others to stay home from school or work when they have the flu until they are fever free for at least 24 hours, although they might be contagious for even longer

While these techniques might not work, they are certainly better than doing nothing and simply letting your kids catch the flu.

What to Do If Your Child Is Exposed to the Flu

If your kids do anything outside the home, even if they don’t go to daycare or school, there might come a time during a long flu season when they get exposed to someone with the flu.

What do you do?

“Prevention (prophylaxis) is a term used when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.”

FDA on Tamiflu: Consumer Questions and Answers

In addition to watching for classic flu symptoms to develop over the next one to four days, if your child is unvaccinated or it is a year during which the flu vaccine is not very effective, if your child is in a high risk group for severe complications from the flu (under age two to five years or any age with chronic medical problems), then you might ask your pediatrician about:

  • a once a day dose of Tamiflu (Oseltamivir), which is recommended as a preventative in infants as young as three months old
  • a once a day dose of Relenza (Zanamivir), which is recommended as a preventative in children as young as five years old, unless they have respiratory problems, like asthma

But that doesn’t mean that everyone should take these flu medicines every time they are exposed to someone with the flu. If these medicines are overused, flu viruses will develop resistance and they won’t work, just like happened to some of the older anti-viral flu medicines, amantadine and rimantadine.

Still, if your child with diabetes, uncontrolled asthma, muscular dystrophy, or healthy four month old is closely exposed to someone with the flu, then taking Tamiflu to prevent a potentially severe case of the flu is likely a good idea.

What to Do If Your Child Gets the Flu

And if your child gets the flu?

Believe it or not, most healthy school age kids with the flu don’t need to be seen by their pediatrician.

“When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen symptoms and shorten the time you are sick by about one day. They may reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults. For people at high risk of serious flu complications, early treatment with an antiviral drug can mean the difference between having milder illness instead of more severe illness that might require a hospital stay.”

CDC on What You Should Know About Flu Antiviral Drugs

You should see your pediatrician or other health care provider at the first sign of flu symptoms if they are at high risk for serious complications of the flu and they might benefit from Tamiflu, which includes those under two to five years old and children with any chronic medical problems.

And of course, seek medical attention if your child with the flu is showing signs of a severe case of the flu, such as trouble breathing, dehydration, or being inconsolable, etc.

You should also seek medical attention if your child with the flu was getting better, but then starts to get worse again, with a return of fever, worsening cough, or severe headache, etc.

When in doubt, call your pediatrician!

What to Know About Protecting Kids from the Flu

In addition to avoiding people who are sick with the flu, see your pediatrician as soon as possible if your younger, high risk child is gets sick after being exposed to someone with the flu.

More on Protecting Kids from the Flu