Tag: measles rash

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

What Are the Signs and Symptoms of Measles?

The first measles vaccine was developed in 1963 and its use led to a quick drop in measles cases in the United States.

In fact, as most people know, the endemic spread of measles was declared eliminated in the United States in 2000.

What does that mean?

A typical case of measles, as described in 1920, doesn't sound very mild or marvelous as some folks claim it to be.
A typical case of measles, as described in 1920, doesn’t sound very mild or marvelous as some folks claim it to be.

For one thing, it means that many people in the United States have never actually seen anyone with measles.

What Are the Signs and Symptoms of Measles?

As we are seeing more and more measles cases each year, it makes it important for everyone to learn how to recognize what measles looks like. Measles is so contagious, that missing just one case can lead to a lot of other people getting exposed unnecessarily and can keep an outbreak going.

So what does measles look like?

Call before you go to the ER or to see your doctor if you think your child has measles so that you don't put others at risk.
Call before you go to the ER or to see your doctor if you think your child has measles so that you don’t put others at risk.

After being exposed, kids with measles will develop:

  • a high fever
  • cough and/or runny nose
  • red, watery eyes with photophobia (dislike of bright light)
  • sore throat
  • irritability
  • decreased appetite

That sounds like many other viral infections that kids get though, which is why measles is so hard to diagnose, at least at the beginning stages of the illness, when kids only have the first signs of measles – the fever, cough, runny nose, and conjunctivitis.

Koplik spots, small gray-white spots in your mouth, are another clue that a child might have measles. They can develop on the second or third day of fever.

Next, after having the high fever for 3 to 5 days, kids develop a worsening fever and the classic measles rash. It is important to note that you are contagious well before you get the rash though, up to about four days before the rash develops, providing plenty of chances to expose others before you ever know you have measles.

“It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body.”

Measles Signs and Symptoms

While many diseases have a fever with or followed by a rash, it is very characteristic of measles that the fever continues for a few more days as the child develops the rash.

“You’ll usually feel most ill on the first or second day after the rash develops.”

Measles Symptoms

This is when most kids get diagnosed, typically with laboratory confirmation.

Unfortunately, because of the high fever and irritability, they may have sought medical attention a few times and could have exposed a lot of people already, especially as you continue to be contagious until you have had the rash for at least four days.

“After a few days, the fever subsides and the rash fades.”

Measles Signs and Symptoms

All together, these classic measles symptoms typically last about a week. As the rash fades, parents might notice staining and then a fine desquamation (skin peeling).

Of course, if any complications develop, the symptoms can last much longer.

What complications? Remember, measles was once called a harmless killer

Complications of measles can include:

  • ear infections
  • diarrhea
  • croup
  • pneumonia
  • seizures
  • encephalitis
  • myocarditis

And tragically, some kids don’t survive having measles.

“Furthermore, the risk of contracting other infections or dying remains high for several months after recovery from acute measles infection.”

Treating Measles in Children

And although most do survive the acute infection, we know that these kids are still at risk for getting other infections in the next few months and are at a later risk for SSPE.

Get vaccinated. Stop the outbreaks. There is no good reason that our kids should have to get measles today.

More on the Signs and Symptoms of Measles

About Those Vaccine Strains in Measles Outbreaks…

A lot happens to control and contain a measles outbreak these days.

For one thing, you have to confirm that everyone with measles symptoms actually has measles. If you miss anyone, because measles is so contagious, then they could expose other people and the outbreak will keep getting bigger.

How do they confirm who has measles and who doesn’t?

While you could just make a clinical diagnosis, simply relying on the person’s history and pattern of symptoms, typically everyone just gets tested.

About Those Vaccine Strains in Measles Outbreaks…

What kind of testing?

“Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction (RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus.”

Measles For Healthcare Professionals

It depends, but often a throat swab or a throat swab and urine are collected for PCR testing, especially if it has been 7 or fewer days since the patient came down with their rash.

If it has been longer than 7 days, then testing using urine and blood specimens can be performed.

“Molecular analysis can also be conducted to determine the genotype of the measles virus. Genotyping is used to map the transmission pathways of measles viruses. The genetic data can help to link or unlink cases and can suggest a source for imported cases. Genotyping is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.”

Measles For Healthcare Professionals

Because many people get vaccinated during an outbreak and a rash and fever is a side effect of the MMR vaccine, testing becomes very important in those who were recently vaccinated.

Statistics from the 2015 Disneyland measles outbreak...
Statistics from the 2015 Disneyland measles outbreak. Anti-vaccine folks, this slide doesn’t mean what you think it means.

After getting vaccinated, testing helps confirm that someone has vaccine strain measles and not wild type, a vaccine reaction, and don’t actually have measles.

“Here, we describe a real-time reverse transcription-PCR (RT-PCR) method that detects the vaccine genotype (MeVA RT-quantitative PCR [RT-qPCR]) and that can provide rapid discrimination between wild-type-virus infections and vaccine reactions.”

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

An no, the vaccine reaction is not that they developed measles! They developed a rash and/or fever, a common side effect of the MMR vaccine.

“During outbreaks, measles vaccine is administered to help control the outbreak, and in these situations, vaccine reactions may be mistakenly classified as measles cases.”

CDC on Genetic Analysis of Measles Viruses

So the reports that you might have seen that 31 people in the California measles outbreak had a vaccine strain of measles aren’t true. There were at least 31 people who were recently vaccinated during the outbreak and had a rash and/or fever, and they tested positive for the vaccine strain, proving that they weren’t actually part of the outbreak. None of them actually had measles though.

Has anyone ever gotten the measles after being vaccinated?

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

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

Yes, there are a few case reports.

Very rare case reports.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

We know who’s responsible for the rise in measles outbreaks and no, it ain’t folks who have recently been vaccinated. Vaccines are safe and necessary.

Get vaccinated. Stop the outbreaks.

More on Vaccine Strains in Measles Outbreaks

Did CNN Apologize for Using a Fake Measles Photo?

We have seen a lot of fake stories since the measles outbreaks started.

Will these folks apologize when they realize that it wasn't a photo of a child suffering an adverse reaction to the measles vaccine?
Will these folks apologize when they realize that it wasn’t a photo of a child suffering an adverse reaction to the measles vaccine?

And they are all from the usual suspects.

Did CNN Apologize for Using a Fake Measles Photo?

And no, I’m not talking about the photo from CNN.

It's not a conspiracy...
It’s not a conspiracy…

So what’s up with the photo?

This photo is in the CDC archives.
This photo is in the CDC archives.

The child in the photo doesn’t actually have measles, although he does have a rash that looks like measles.

“This 1968 image depicted the face and back of a young child after receiving a smallpox vaccination in the right shoulder region. Note the erythematous halo surrounding the vaccination site, which can also be seen in PHIL 13321 and 13323, as well as a morbilliform skin rash, i.e., resembling measles, consisting of numerous flattened erythematous, amorphous macules. This child was subsequently diagnosed with roseola vaccinia.”

Public Health Image Library (PHIL)

And it is a photo of a child of a vaccine reaction, a reaction to his smallpox vaccine.

Why did CDC use that photo?

Who knows, but there aren’t a lot of photos of kids with measles out there. They likely found a stock photo of a kid with a rash that looked like measles and used it.

Learn the risk of following the advice of Brandy Vaughan.
Learn the risk of following the advice of Brandy Vaughan.

Still, while they didn’t use a photo of a child with measles, they also didn’t use a photo of a child that got measles from the vaccine, as Brandy Vaughan claims.

And of course, the rest of the story about Washington being under a state of emergency still stands, as measles cases continue to rise.

More on Did CNN Apologize for Using a Fake Measles Photo?

News on the Latest Measles Outbreaks of 2019

Breaking News – 31 new cases in Brooklyn (see below).

2019 has just started, but we already have reports of measles cases and exposures in at least 674 people in 23 states, including Arizona (1), California (23), Colorado (1), Connecticut (3), Florida (1), Georgia (3), Hawaii (2), Illinois (5), Indiana (1), Iowa (2), Kentucky (2), Massachusetts (1), Michigan (42), Mississippi (1), Missouri (1), Nevada (1), New Hampshire (1), New Jersey (13), New York (470), Oregon (11), Tennessee (1), Texas (14), and Washington (73).

And large, ongoing outbreaks in New York (Brooklyn and Rockland County) and the Pacific Northwest.

Measles is still spreading in New York.

There are also many reports of measles outbreaks in Europe.

2019 Measles Outbreaks

Since there were so many ongoing measles outbreaks in 2018, it shouldn’t be surprising that we are getting off to a quick start in 2019.

Recent cases and exposures include:

  • someone in Oregon who exposed other people in Portland (Jan 2), The Dalles (Dec 29 and 31, 2018), and Hood River (Dec 30, 2018)
  • an unvaccinated toddler in Monroe County, New York who had recently traveled to Ukraine
  • 9 new cases in Rockland County, New York (105 total)
  • 3 new cases in the Borough Park and Williamsburg sections of Brooklyn (55 total)
  • 3 new cases in Rockland County, New York (108 total)
  • a new outbreak in Clark County, Washington involving two unvaccinated children who exposed others on Jan 6 and 7 and an additional 11 suspected cases
  • 6 new cases in Rockland County, New York (114 total)
  • as expected, 12 more cases in Clark County, Washington (14 total) – all children, all unvaccinated (one unverified), with multiple exposures in Vancouver, including 5 different schools, 2 churches, and 6 health care facilities
  • 3 new cases in the Borough Park section of Brooklyn (58 total)
  • an adult in Denver, Colorado who became sick while traveling internationally and exposed others in Denver from Jan 10-14
  • 2 more cases in Clark County, Washington (16 total), with 5 more suspected cases remaining and exposures in Battle Ground (Jan 8 and 14) and Vancouver (Jan 14 and 15)
  • 2 kids from the Washington outbreak had traveled to Hawaii while contagious (January 4 to 13)
  • 2 residents of the metro Atlanta area, with exposures between Jan 7 to 14, although there is some speculation that these cases were also travelers from the Washington outbreak
Are these cases part of the Washington outbreak?
After 19 cases and an exposure at the Portland Trail Blazers game, Clark County has declared the measles outbreak to be a public health emergency.
After 19 cases and an exposure at the Portland Trail Blazers game, Clark County has declared the measles outbreak to be a public health emergency.
  • 3 more cases in Clark County, Washington (19 total), with 7 more suspected cases remaining and exposures in Camas (Jan 10- 15), Portland (Jan 11 and 14), and Vancouver (Jan 11 to 16), leading the Clark County Council Chair Eileen Quiring to declare a public health emergency.
  • 2 new cases in Clark County, Washington (21 total), with 4 more suspected cases remaining and exposures in Vancouver (Jan 7 to 11)
  • 4 new cases in the Borough Park and Williamsburg sections of Brooklyn (62 total)
  • 2 new cases in Rockland County, New York (118 total)
  • 2 new cases in Clark County, Washington (23 total), with 2 more suspected cases remaining and exposures in Vancouver (Jan 15 and 19) and Portland (Jan 15-16), including at the Portland International Airport (where did they go?)
  • 4 new cases in Rockland County, New York (122 total)
  • a case in the Champaign-Urbana Public Health District in Illinois with multiple exposures (Jan 12 to 19) including the University of Illinois in Urbana and Champaign
  • 2 new cases in Clark County, Washington (25 total), with 12 more suspected cases!
  • a case in King County, Washington that is linked to the outbreak in Clark County
  • 5 new cases in Clark County, Washington (30 total), with 9 more suspected cases!
  • a case in Multnomah County, Oregon that is linked to the outbreak in Clark County and with exposures (Jan 20 to 23) in Gresham, Wood Village, and Troutdale
Hopefully, no kids with immune system problems were exposed to these kids with measles.
Hopefully, no kids with immune system problems were exposed to these kids with measles.
Almost all of the measles cases in Rockland County are unvaccinated.
There are now 147 measles cases in Rockland County.
Rockland county executive Ed Day declared a local state of emergency over the ongoing measles outbreaks in the area on March 26.
As of March 28, the CDC is reporting 387 measles cases in 2019, the third highest number of cases in a year since 1994.
  • a new case in Boston, Massachusetts, with exposures in Plymouth, Waltham, Framingham, Hyannis, and Braintree (March 26 to 31)
  • 8 new cases in Oakland and Wayne counties in Michigan (30 total)
  • 1 new case in Rockland County (158 total)
  • 3 new cases in Rockland County (161 total)
  • 45 new cases in the Borough Park, Crown Heights, Williamsburg, and Flushing sections of Brooklyn (259 total)
  • 5 new cases in Rockland County (166 total)
  • 4 new cases in Oakland and Wayne counties in Michigan (34 total)
  • a new case in Dallas County, Texas that is linked to a previous case in Tarrant County
  • another case in Kentucky, a sibling of an unvaccinated child who developed measles last month
  • 5 new cases in Oakland and Wayne counties in Michigan (39 total)
Williamsburg press conference on April 9.
  • 26 new cases in the Williamsburg section of Brooklyn (285 total), as Commissioner of Health declares a public health emergency and orders unvaccinated people in the 11205, 11206, 11221 and/or 11237 zip codes to be vaccinated within 48 hours
  • 2 new cases in Rockland County (168 total), as they discuss a plan to keep unvaccinated people at home
  • 2 new cases in Oakland, Washtenaw and Wayne counties in Michigan (41 39 total)
  • a new case in the Bronx, New York, with exposures at Montefiore Medical Center (April 9).
  • 8 unvaccinated kids (the youngest only 6 months old) in Northern Westchester, New York and who were exposed in Brooklyn and Rockland
  • 5 new cases in Rockland County (173 total), as they discuss a plan to keep unvaccinated people at home
  • 7 new cases in Rockland County (180 total), as they discuss a plan to keep unvaccinated people at home
  • 4 new cases in Rockland County (184 total), as they discuss a plan to keep unvaccinated people at home
  • 4 new cases in California, including Santa Clara and Butte, Calaveras, Shasta, Tehama Counties
  • a new case in Washtenaw County, Michigan that is unrelated to the an ongoing outbreak in the area, with exposures at 18 sites, including the University of Michigan, Walgreens, CVS, Whole Foods, and DTW Airport McNamara Terminal (April 4 to 6)
  • a new case in New Haven County, Connecticut, linked to travel to Brooklyn
  • 2 new cases in Rockland County (186 total), as they discuss a plan to keep unvaccinated people at home
  • 44 new cases in the Borough Park, Midwood/Marine Park, Far Rockaway, and Williamsburg sections of Brooklyn (329 total)
  • 4 new cases in Rockland County (190 total), as they impose new orders for the quarantine of anyone diagnosed or exposed to someone with measles
  • 2 new cases in Oakland County and the City of Detroit, Michigan, with exposures in Oak Park, Lansing, Grand Rapids, and Ypsilanti (April 10 to 13)
  • a new case in Iowa, unvaccinated contact of the first case in the state
  • 3 new cases in Rockland County (193 total)
  • a case in Tennessee, with exposures in Chattanooga and Clinton (April 11-12) and who traveled through Alabama (April 11)
  • 30 new cases in the Borough Park and Williamsburg sections of Brooklyn (359 total)
  • 20 cases in Orange County, New York, including a mother and her baby who were hospitalized
  • 6 new cases in Rockland County (199 total)
  • a case in Mississippi, with exposures in Hattiesburg (April 9-10)
  • 31 new cases in the Brighton Beach, Williamsburg, and Hunts Point, Longwood and Melrose sections of Brooklyn (390 total)

What kind of measles year will 2019 turn out to be? Unfortunately, we already have the potential for another record year…

These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.

For More Information On Measles Outbreaks:

Updated on April 24, 2019

Do You Know What Vaccine-Preventable Diseases Look Like?

Odds are that you have never seen anyone with smallpox, but what about measles or mumps?

No?

Have you ever even seen someone with chicken pox?

Photos of Vaccine-Preventable Disease

Maybe if more folks knew what typical vaccine-preventable diseases looked like, then they wouldn’t be so quick to think about skipping or delaying their kids vaccines.

And they certainly wouldn’t think that these are mild diseases that they wanted their kids to get, thinking natural immunity would be better than the immunity that they could more easily and safely get from a vaccine.

Severe dehydration in a child with a rotavirus infection.
Severe dehydration in a child with a rotavirus infection.

Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat.
Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat. Photo by the Japanese Society of Tropical Medicine

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Newborns and infants have the highest rates of death from pertussis.
Newborns and infants have the highest rates of death from pertussis or whooping cough.

An infant with measles during the 2014 outbreaks in the Philippines.
An infant with measles during the 2014 outbreaks in the Philippines. Photo by Jim Goodson, M.P.H.

Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.
Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.

A baby with a congenital cataract and blueberry muffin rash - classic signs of congenital rubella syndrome.
A baby with a congenital cataract and blueberry muffin rash – classic signs of congenital rubella syndrome. (CC BY-NC-SA)

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.
This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.

Chronic hepatitis B is a silent killer.
Chronic hepatitis B is a silent killer.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.
Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcal disease.

In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath.
In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath. Seen here are the ‘thumb sign’ on X-ray and the cherry red epiglottis.

Before wide use of the Hib and Prevnar vaccines, infants with fever would routinely get spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a bacterial infection).
Before wide use of the pneumococcal vaccines, infants with fever would routinely a get spinal tap to make sure that they didn’t have bacterial meningitis.

If a mother get chicken pox late in her pregnancy, her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life.
If a mother get chicken pox late in her pregnancy, then her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life. (CC by 3.0)

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. (CC by 3.0)

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

As in most years, flu deaths in children mostly occurred in kids who weren't vaccinated.
As in most years, flu deaths in children mostly occurred in kids who weren’t vaccinated.

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which?
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which?

Surprisingly, treatments haven't changed much since this photo was taken of a patient with yellow fever in 1898.
Surprisingly, treatments haven’t changed much since this photo was taken of a patient with yellow fever in 1898.

Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella typhi bacteria to other people.
Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella Typhi bacteria to other people.

Japanese encephalitis is spread by mosquito bites.
Japanese encephalitis is spread by mosquito bites.

I know what some of you are thinking. And no, just because these vaccine-preventable diseases aren’t as common as they used to be doesn’t mean that any of these vaccines aren’t necessary.

Why not?

We don’t see them as much as we did in the pre-vaccine era simply because these vaccines work!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

We all know what happens if we stop vaccinating.

And it is not just that we get a few updated photos of kids with measles, mumps, diphtheria, and other vaccine-preventable diseases…

More on Photos of Vaccine-Preventable Diseases