Tag: measles rash

Vaccine Induced Measles

Why are anti-vaccine folks still pushing the idea that vaccine induced measles is a thing?

This study is not about vaccine induced measles.
This study is not about vaccine induced measles.

In yet another example of anti-vaccine folks inappropriately using a real vaccine study, the ironically named Physicians for Informed Consent continues to push the idea that many measles cases are caused by the MMR vaccine.

Vaccine Induced Measles

They aren’t…

The study they are citing, Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR, simply talks about how to “distinguish between measles cases and vaccine reactions.”

“During measles outbreak investigations, rapid detection of measles vaccine reactions is necessary to avoid unnecessary public health interventions.”

Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

While many of these people do test positive for a vaccine strain, they do not actually have measles. They typically just have a rash and/or fever, with a concern that they might have measles because they are in the middle of a measles outbreak.

But if they have a rash and fever and test positive for measles, even if it is a vaccine strain, why shouldn’t we just say that they have measles?

Because measles isn’t just about having a rash and fever. It is having a specific pattern of a high fever for 3 or 4 days, then developing a rash, and continuing to have a fever. People with measles also typically have other symptoms, including irritability, cough, coryza, and conjunctivitis.

Confirmed Case Counts in Measles Outbreaks

Still, since these measles vaccine reactions can get confused with real measles cases, do they inflate the measles case counts in our outbreaks?

Testing helps to make sure that only real cases of measles are included in outbreak case counts.
Testing helps to make sure that only real cases of measles are included in outbreak case counts.

They don’t.

While we occasionally do see a “confirmed” case later change as further testing is done, it is important to realize that most cases are thoroughly evaluated to see if they are in fact really measles.

Most case counts are made up of confirmed cases and don’t include suspected cases that might be someone who has a rash after their MMR vaccine or some other viral infection.

“Vaccine‐associated measles is a possible, but extremely rare event.”

Sood et al on Vaccine‐associated measles in an immunocompetent child

Anyway, vaccine induced or vaccine associated measles is extremely rare.

What about the fully vaccinated woman in New York who developed measles, getting four other people sick in 2011?

Didn’t she have vaccine induced measles?

Nope.

“This is the first report of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. “

Rosen et al on Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

She had the D4 strain of measles – not a vaccine strain.

Who Gets Measles?

Most people who get measles are unvaccinated, often intentionally unvaccinated.

Trying to get you to think that many people in an outbreak have a vaccine strain is just another propaganda technique to scare you away from vaccinating and protecting your kids.

Don’t fall for it!

Two doses of MMR are the best protection against measles.

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

More on Vaccine Induced Measles

Who Is Kenneth Stoller?

It is well known that there are doctors in California writing fake medical exemptions for kids so that they can avoid getting vaccinated and protected.

Tara Zandvliet isn't the only one writing a lot of medical exemptions for vaccines.
Tara Zandvliet isn’t the only one writing a lot of medical exemptions for vaccines.

Just who these doctors are is probabaly a bit of a mystery to a lot of people.

Who Is Kenneth Stoller?

In addition to Tara Zandvliet in San Diego, Kenneth Stoller has been writing a lot of medical exemptions for kids in California.

Did Kenneth Stoller get referrals for medical exemptions through anti-vaccine groups on Facebook?
Did Kenneth Stoller get referrals for medical exemptions through anti-vaccine groups on Facebook?

In fact, he has been writing so many that he got the attention of the City Attorney in San Francisco, who is investigating “whether the San Francisco doctor has been unlawfully providing medical exemptions that allowed parents to avoid vaccinating their children, which would put those children, their playmates, their schoolmates, and the general public at greater risk of contracting a communicable disease.”

In a response to this investigation, which includes a subpoena for his medical records, Ken Stoller admits that he “issues exemptions based on considerations not listed as CDC contraindications and precaution.”

“In conclusion, the invalid interpretation that the determination of the MTFHR variant is an acceptable reason for vaccine exemptions is not based on the precepts of replication and rigorous clinical testing. It is unfortunate that the loose application of our exploratory report has been misinterpreted and used to inappropriately justify exemption of children from medically indicated vaccines.”

David M Reif, Ph.D. on the Inappropriate Citation of Vaccine Article

Since the CDC list of contraindications and precautions is what most people consider the standard of care for a medical exemption, it is a little hard to understand what his defense will be? It isn’t the continued use of MTHFR testing, is it?

“There is no published information as of yet as to how many of the 10 measles cases in children were the wild measles strain, (i.e., unvaccinated children, versus children who contracted symptoms from the vaccine, like the 38% in the Disneyland outbreak), or how many were vaccinated and contracted wild measles due to primary vaccine failure, which may be 10% or more.”

Complaint/verified Petition to Quash an Administrative Subpoena, for Declaratory and Injunctive relief against the Subpoena and in Support of an Alternative Standard of Vaccine Exemptions Recognized Under California Law

Is he going to push the myth that kids in California have vaccine strain measles?

This is not vaccine strain measles, an idea that anti-vaccine folks continue to push to scare parents away from vaccinating and protecting their kids.
This is not vaccine strain measles, an idea that anti-vaccine folks continue to push to scare parents away from vaccinating and protecting their kids.

Although some vaccine strains were detected in 2015, they were not in people who actually had measles.

“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.”

Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

They are people with a febrile rash illness. The rash and fever is a vaccine side effect. It is not vaccine-associated measles.

And primary vaccine failure is not very common at all, which is why most cases are in those who are unvaccinated.

Kenneth Stoller on Vaccines and Autism

What else does Dr. Stoller believe?

“For many children, the enviornmental illness that we have incorrectly been calling autism, is actually an illness that has been exacerbated by too many toxic vaccines. Contrary to popular belief, there are plenty of people in governmental circles who know that certain vaccine ingredients, such as ethyl mercury, found in the perservative thimerosal, will cause neurobehavioral problems and negatively impact the health of vaccinated children.”

Kenneth Stoller

Autism as encephalopathy, biomarkers, testing urine porphyrins, chelation therapy, detoxification, hyperbaric oxygen therapy – it’s all there. And it is all the type of autism-vaccine misinformation that experts say to avoid.

Many will wonder why the medical board hasn’t paid him a visit before the City Attorney in San Francisco came calling.

Is it a surprise that Kenneth Stoller found 'valid health reasons' for them to skip their daughter's vaccines?
Is it a surprise that Kenneth Stoller found ‘valid health reasons’ for them to skip their daughter’s vaccines?

But few should have any doubt that SB 276 needs to pass.

More on Kenneth Stoller

How Could Seven of My Vaccinated Kids Have the Measles Right Now?

Seven vaccinated kids with measles?!?

But doesn’t the measles rash typically show up after three to five days of fever?

Wait, that couldn’t really happen, could it? Seven vaccinated kids with measles in one family?

How Could Seven of My Vaccinated Kids Have the Measles Right Now?

While anything is possible, this story is very improbable once you look at the details…

“When her 12-year-old son spiked a fever and started complaining of a sore throat right before Passover, Mrs. Pearl (not her real name) wasn’t worried. She confidently crossed off a host of possible infections that he was fully vaccinated for.

She thought he had strep throat, like two of his siblings.

They headed to urgent care for a rapid strep test, but the result was negative. Undeterred, she put her son on antibiotics at the nurse’s recommendation, and sent her son to bed.

He’d worsened by morning.

He woke feeling feverish and broken out in a rash.”

Jennifer Margulis

Could that be measles?

He ended up testing positive for measles, even though he was fully vaccinated. Only two days of fever before he developed his rash though, and no word that the fever continued, as you would expect with measles…

“Not long after, Mrs. Pearl’s 10-year-old broke out in a similar rash.

This child didn’t spike a fever but his breathing was labored and he complained that his eyes hurt.

He also tested positive for the measles.”

Jennifer Margulis

Although they all could have been exposed to someone else, it is important to note that the incubation period for measles is 7 to 14 days. The “not long after” scenario sounds like too short a time to get “measles” from his brother. Also, no fever, which would be very strange for measles…

But the other five kids had more classic symptoms of measles, right?

Nope.

“Of the seven other children that Mrs. Pearl had tested—all of whom had been fully vaccinated—five more showed no immunity to measles.”

Jennifer Margulis

What about the negative titer tests?

That’s actually not unusual after measles vaccination. It’s not proof or any kind of indication that the vaccine didn’t work. It has been long known that most vaccinated people who have negative measles titers will show an anamnestic immune response if they get another dose of MMR.

What does that mean? It means that they were likely immune, even with the negative titer.

“In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing.”

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices

In fact, we don’t routinely check titers after MMR, at least not for measles.

And their symptoms?

“Two hours after getting the MMR booster, Mrs. Pearl’s 16-year-old spiked a 102-degree fever and broke out in a measles rash.

Four days later her three other children, all of whom had received the MMR booster, all had measles rashes, canker sores in their mouths, gastrointestinal problems, and lethargy.”

Jennifer Margulis

Canker sores with measles? Kids with measles get Koplik spots, but no one describes them as canker sores.

Fever and a rash developing at the same time?

Yeah, none of that sounds like measles. At all.

Remember, the classic symptoms of measles include 3 to 5 days of a high fever with cough, coryza, and conjunctivitis, followed by a rash, with continued fever.

“According to Mrs. Pearl, the health department official also told her that measles vaccine failure is common and that about half the people getting measles in the current measles clusters in Brooklyn are fully vaccinated.”

Jennifer Margulis

Actually, only 27 of the 566 people in Brooklyn with measles have been known to be fully vaccinated, with two doses of MMR. How much less than half is that? It is less than 5% of cases.

Measles vaccine failure is not common at all.

Why Did They Say That Seven of My Vaccinated Kids Have Measles?

So how do you explain what happened to this family?

Besides the likelihood that they had another, more common virus causing their symptoms? With mouth ulcers and diarrhea, like maybe Coxsackie virus?

Do you really need another explanation?

How do you explain the positive measles tests?

They were almost certainly a false positive.

“The test kits in use have been shown to have high sensitivity and specificity. However, cross-reactions with other viral diseases, e.g. rubella and Parvovirus, may occur.”

Dietz et al on The laboratory confirmation of suspected measles cases in settings of low measles transmission: conclusions from the experience in the Americas.

They didn’t state which test was done, but it is important to note that several are available. This includes an immunoglobulin test, PCR from a throat swab, and PCR from a urine specimen. The most accurate testing is done by the CDC.

“Detection of specific IgM antibodies in a serum sample collected within the first few days of rash onset can provide presumptive evidence of a current or recent measles virus infection. However, because no assay is 100% specific, serologic testing of non-measles cases using any assay will occasionally produce false positive IgM results.”

Serologic Testing for Measles in Low Prevalence Setting

Did they have confirmatory tests, after their initial positive test? Were they done at a state lab? Did all of her other kids test positive for measles?

“She’s angry at the measles vaccine failure and worried about her family members, especially her pregnant daughter.”

Jennifer Margulis

She should be angry at folks pushing misininformation in her community.

“I used to think people who don’t vaccinate were crazy,” Mrs. Pearl says. “Now I’m not so sure. Maybe they’re right. Maybe my body doesn’t want to take garbage. Something is a red flag. After my story, I’m not so sure where the measles started. I’m legit. I did vaccinate. All my kids are up to date. Children ages 22 to 7 all getting the measles?”

Jennifer Margulis

Something is indeed a red flag. To get to the bottom of it, Mrs. Pearl should revisit the idea that her kids really had measles.

More on Vaccinated Kids with Measles

What Should You Do If Your Child Might Have Measles

As you hear more and more about measles outbreaks, eventually you might think that your child has measles.

Why?

Until a child develops the classic measles rash, the symptoms of measles can mimic many other more common viral illnesses, as they include fever, cough, coryza, red eyes, and irritability.

What Should You Do If Your Child Might Have Measles

And while many other viruses can cause a fever and rash, it is really only measles that causes the classic pattern of 3 or 4 days of high fever, followed by the appearance of a rash with continued fever.

Unfortunately, by the time your child has developed the rash, you may have already have gone to the doctor or ER a few times, exposing a lot of people to measles.

If your child has measles, don’t give it to anyone else.

That’s why it’s important to try and recognize measles as early as possible, so that you don’t expose anyone else and get them sick too.

It is especially important to think about measles if your child:

  • traveled out of the country in the past 7 to 21 days, the incubation period for measles
  • recently traveled to or lives in an area that is experiencing measles outbreaks
  • is not yet fully vaccinated, with two doses of MMR, keeping in mind that a small minority of people can get measles even if they are fully vaccinated

So what do you do if your child might have measles?

Ideally, you would call your health care provider, clinic, or emergency room ahead of time and let them know that you are concerned about measles. That allows them to take steps to minimize the risk that your child will expose others to measles.

While the child is isolated, health care professionals can then decide if it is necessary to do further testing for measles. If they do suspect measles, they may even call the local health department for further help.

If necessary, post-exposure prophylaxis might also be provided for the child’s contacts.

What if you aren’t sure if your child has measles? Put a mask on them anyway if there is any doubt! Don’t take a chance on causing a big outbreak.

During some outbreaks, communities have even had to implement universal masking of all patients and all family members to help get their outbreak under control.

And remember that the best way to stop these outbreaks is for everyone to get fully vaccinated on time and on schedule.

More on Measles Exposure Prevention Measures