Tag: complications

Do Vaccinated Kids Who Get Sick Have Milder Disease?

There is another benefit of vaccines that you might not be aware of.

Vaccines are typically very effective, but of course, they aren’t perfect.

Fortunately, even when they don’t work and you do get sick, vaccinated kids will often have milder disease than those who are unvaccinated.

Do Vaccinated Kids Who Get Sick Have Milder Disease?

While no one expects to get a vaccine-preventable disease if they have been vaccinated, it is nice to know that often, you will at least have a milder disease.

“Disease may occur in previously vaccinated individuals. Such breakthroughs are either primary – due to vaccine failure – or secondary. In such cases, the disease is usually milder than in the non-vaccinated.”

Vaccination greatly reduces disease, disability, death and inequity worldwide

Milder mumps and pertussis?

“The number of previous vaccine doses was inversely associated with clinical severity.”

Zamir et al on Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases

Yes!

And that’s good news for all of the folks concerned about waning immunity with these vaccines.

“A protective effect of vaccination was noted when mean duration of symptoms and hospital stay are analysed, comparing unvaccinated, partially vaccinated and fully vaccinated children. We showed a vaccination dose effect trend, with fully vaccinated children having less-severe RVGE than not vaccinated and partially vaccinated children.”

Justino et al on Clinical Severity and Rotavirus Vaccination among Children Hospitalized for Acute Gastroenteritis in Belém, Northern Brazil

Consider that, in addition to preventing disease:

  • two doses of MMR has been found to have a significant preventive effect against mumps complications, including orchitis, meningitis, and encephalitis, and hospitalization for mumps
  • two doses of the chickenpox vaccine has been found to be very effective at preventing severe disease, in fact, kids with breakthrough chickenpox often don’t have fever, have fewer than 50 spots, and they go away quicker than kids who are unvaccinated.
  • vaccinated kids who get pertussis typically don’t cough as long as those who are unvaccinated
  • the rotavirus vaccine series, in addition to protecting most kids from getting rotavirus infections in the first place, protected all of the vaccinated kids from getting severe infections
  • the flu vaccine reduces the risk of severe disease, especially if you are hospitalized with the flu

What does this all mean?

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots...
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots…

It means that vaccines work, even when they don’t work as well as we would like them to!

More On the Severity of Breakthrough Infections

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

Why Do We Include SSPE When Counting Measles Deaths?

Anti-vaccine folks often like to push the idea that parents shouldn’t worry about measles and that it is just a rash with a little fever.

They leave out the part that it is a week of having a high fever, irritability, and other symptoms too.

In addition to downplaying the symptoms of measles, they never talk about the possible complications, such as encephalitis, seizures, and death.

Why Do We Include SSPE When Counting Measles Deaths?

They certainly never talk about SSPE or subacute sclerosing panencephalitis.

“Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus.”

Subacute Sclerosing Panencephalitis Information Page

SSPE is a late complication of having a natural measles infection.

That’s why it should be included when counting measles deaths.

“Available epidemiological data, in line with virus genotyping data, do not suggest that measles vaccine virus can cause SSPE. Furthermore, epidemiological data do not suggest that the administration of measles vaccine can accelerate the course of SSPE or trigger SSPE in an individual who would have developed the disease at a later time without immunization. Neither can the vaccine lead to the development of SSPE where it would not otherwise have occurred in a person who has already a benign persistent wild measles infection at the time of vaccination.”

Subacute sclerosing panencephalitis and measles vaccination

It is not a complication of having a measles containing vaccine. If it were, then why didn’t we see more cases of SSPE as more and more people got vaccinated, instead of a drop in SSPE cases and deaths, corresponding to a drop in measles cases?

But SSPE isn’t gone yet, just like measles hasn’t yet been eradicated.

32 of these SSPE deaths have been since 2000. Source is the CDC Wonder database.
32 of these SSPE deaths have been since 2000. Source is the CDC Wonder database.

Since 2000, when the endemic spread of measles was eliminated in the United States, there have been at least 37 SSPE deaths.

“Investigators learned that, in 2012, at age 11 years, the boy, who was previously healthy and developmentally normal, had been admitted to a tertiary care children’s hospital in Oregon with severe, progressive encephalopathy. Before the onset of his neurologic illness, the patient had been a straight-A, fifth-grade student who played soccer and basketball. The symptoms began approximately 4 months before the hospital admission, when the patient began to struggle with homework, drop utensils, and doze off during meals, eventually progressing to falling asleep while walking.”

Notes from the Field: Subacute Sclerosing Panencephalitis Death — Oregon, 2015

I say at least, because the CDC Wonder database doesn’t list the 2015 SSPE death of a boy in Oregon.

Anti-vaccine folks like to ignore the fact that yes, people have died of measles recently. And measles puts you at risk for SSPE, which is always fatal.
Anti-vaccine folks like to ignore the fact that yes, people have died of measles recently. And measles puts you at risk for SSPE, which is always fatal.

We are fortunate that no one has died since 2015, but as we get more and more measles cases, tragically, in addition of the risk of someone dying of measles directly, it increases the risk that someone will eventually develop SSPE.

“Decreasing rates of vaccination in the United States, particularly among preschool-aged children (children <5 years of age) living in inner-city areas, resulted in a resurgence in the number of cases of measles reported during 1989–1991; during this period, 55,622 cases of measles and 123 measles-associated deaths were reported.”

Bellini et al on Subacute Sclerosing Panencephalitis: More Cases of This Fatal Disease Are Prevented by Measles Immunization than Was Previously Recognized

Remember, there were at least 12 extra SSPE deaths following the large measles outbreaks of the late 1980s.

Will we see any after the rise in the cases the last few years?

Vaccines are safe, with few risks, and obviously necessary.

Don’t risk a complication of measles. Don’t risk getting SSPE.

More on SSPE Deaths

What Do We Know About the Rockland County Measles Outbreak?

Breaking News – there are 10 new cases in Rockland County, bringing the total in this ongoing outbreak to 225, as they institute new orders to quarantine anyone with measles or exposed to anyone with measles (see below

We know a lot about the measles outbreak in Rockland County, New York.

Nothing about what Del Bigtree and Sharyl Attkisson have been saying is right.
Did Del Bigtree or Sharyl Attkisson ever correct their false statements about the Rockland outbreak?

That makes it easy to spot anti-vaccine propaganda.

What Do We Know About the Rockland County Measles Outbreak?

What do we know?

We know that the outbreak is still growing.

And we know that most of the folks in the outbreak are unvaccinated.

10 new cases this week

What else do we know?

“At the end of September 2018, an international traveler arrived in Rockland County with a suspected case of the measles.”

Rockland County Measles Information

The outbreak is already the largest in New York State since the 1990s, before the endemic spread of measles was declared eliminated in the United States.

While it is unlikely to surpass the Ohio measles outbreak of 2014, which reached 384 cases, the Rockland County outbreak has already lasted longer.

In fact, this might will be one of the longer outbreaks is the longest outbreak we have had in a long while since the endemic spread of measles was eliminated in the US in 2000.

OutbreakCasesDuration
Brooklyn outbreak 2013583/13 to 6/9
Ohio outbreak 20143843/24 to 7/23
Disneyland outbreak 201514712/28 to 4/16
Minnesota outbreak 2017793/30 to 8/25
Rockland County outbreak 2018
2259/18 – ?
Brooklyn outbreak 201846610/18 – ?

The Minnesota outbreak of 2017 lasted nearly 5 months, but that includes the 42 days that they went measles-free.

Why 42 days? That’s equal to two incubation periods and if that much time has passed since the last person was infectious, there is little danger that there is still a missed case of measles in the community.

However, since there have been recent cases in Rockland County, we would be are now into the 6th month, mid-March, to get to that same point now.

Why has this outbreak been so hard to control?

“8 separate index cases, all with exposures to ongoing measles outbreak in Israel.”

Measles Review for Providers

Folks keep reintroducing measles into the community!

And immunization rates in the zip codes most affected by the outbreaks were as low as 54% at the start of the outbreak.

What else do we know?

Nine schools, now in compliance, were fined because they didn’t follow the Rockland County Health Commissioners order to keep unvaccinated and undervaccinated students out of school and provide immunization records and attendance records to the Rockland County Department of Health.

“ALL schools within the Village of New Square and any school with less than an 80% MMR vaccination rate within the geographical area affected by the measles outbreak (Spring Valley, Monsey) will be required to keep un- or under-vaccinated students home until 21 days have passed since the last confirmed measles case in Rockland.”

Health Department Announces Increased School Exclusions Due to Measles Outbreak

We don’t know why they aren’t quarantining all intentionally unvaccinated kids from school until the outbreak is over…

We do know that at least six people have been hospitalized in the Rockland County measles outbreak, including one child who ended up in the pediatric intensive care unit.

And we know that vaccines are safe and necessary! Get vaccinated and stop the outbreaks.

“Children 6 months through 11 months of age get an MMR vaccine now. Getting an MMR vaccine now will help give them some protection against measles. They will still have to get a vaccine at 12-15 months of age and again at 4-6 years of age.

Children 1 through 3 years of age who have already received their first MMR vaccine should get a second MMR vaccine now, as long as 28 days have passed since the first MMR vaccine was given to them. This second MMR vaccine will count for school entry.”

In fact, in Rockland County and other areas being hit with an outbreak, kids should get an early MMR, when they are six months old. And they can get their second dose early too, as early as 4 weeks after their first dose when they turn 12 months old.

Lastly, we know that you shouldn’t believe any of the anti-vaccine misinformation that is going around that might scare you away from vaccinating and protecting your kids. That’s why we have these outbreaks…

More on the The Rockland County Measles Outbreak

Updated May 8, 2019