Tag: measles symptoms

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.

Remembering Measles

I don’t remember treating any kids with measles in medical school or residency.

We certainly saw a lot of other now vaccine-preventable diseases when I was in training, from rotavirus and pneumococcal disease to meningococcal disease.

“When I graduated from medical school, many of the current vaccines were either not yet invented or just beginning to be widely used. I still remember what health care was like in the pre-vaccine era, and I remember that there seemed to be at least one child in each neighborhood who spent much of her life in an iron lung because of polio. As a young resident in pediatrics, I heard, on the whooping-cough ward, the coughing and choking of children with pneumonia. I remember the brain damage from encephalitis caused by measles, and the birth defects of babies whose mothers had had German measles during pregnancy. In my first years in pediatric practice, I remember making hospital rounds every morning and treating children with meningitis, and complications of chicken pox and other illnesses that have been either eliminated or lessened in severity by the widespread use of vaccines. Also, I remember more than a decade ago when Great Britain temporarily stopped the routine use of the DTP vaccine because of a reaction scare (which later turned out to be a false alarm) and consequently suffered a resurgence of whooping cough. Because of my “historical” perspective, I have grown to appreciate the value of vaccines as a necessary public-health measure. Currently in our pediatric practice, we follow the vaccine schedule recommended by the American Academy of Pediatrics.”
Dr. William Sears on Ask Dr. Sears: Vaccination/Immunization Concerns

But I trained in the post-elimination era for measles.

Remembering Measles

Although some folks only seem to have the Brady Bunch to use as a guide, fortunately there are many other ways to discover what measles used to be like.

I asked some of my old instructors…

“Typical case of measles – a couple days of high fever, with a sick (miserable) looking kid with running nose, bad cough, and red eyes. You can see Koplik’s spots if you know to look for them on the buccal mucosa (I describe them as grains of salts on red tablecloth). Fever gets higher and rash appears at peak of fever (day 3-4). The rash disappears with a brawny hyperpigmented appearance. The child frequently gets diagnosed with an ear infection. If no complications (ear infection or pneumonia), recovery is quick once the fever resolves, but these kids look really sick, miserable, and sad during the acute phase. They have a measly look.”
Jeed Gan, MD

After reading that account, I’m glad my kids are all vaccinated and protected and hopefully won’t ever get measles, as it sounds horrible.

Although I have never seen it, I can certainly imagine that measly look…

A child with measles and four days of the classic measles rash. Photo by CDC/NIP/ Barbara Rice

What else can you imagine?

“I’ve often called measles ‘the harmless killer’ because, although most youngsters recover uneventfully, the disease a certain amount of really serious damage.”
Dr. Joseph Molner

Can you imagine intentionally leaving your kids unvaccinated and at risk of a harmless killer disease?

In this 1959 article in the Madera Tribune, Dr. Bundesen warns parents to take measles seriously.

It is important to note that even a “mild” attack included a fever that could hit 104F or higher and, altogether the symptoms could last up to 12 days, as the cough often lingers after the rash has cleared up.

And in the pre-vaccine era, everyone ended up having measles, as it was so contagious.

Not everyone survived having measles though.

Even after improved sanitation and hygiene dropped mortality rates for measles and other diseases in the early part of the 20th Century, a lot of kids still died with measles.

It was once well known that measles was not always so easy on kids.

Why have so many folks forgotten that fact?

Do you think that a 106F fever comes with a mild disease?

Is it because vaccines work so well that we don’t see or hear about measles that much anymore?

At least we don’t hear about them until immunization rates drop and we start having more and more outbreaks.

Is that what it’s going to take to get you to vaccinate your kids? An outbreak in your city? Your child’s school? Or are you going to wait until your kids get sick?

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.

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.

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.

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?

2 new cases in Rockland County, New York (116 total)

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.

two more cases in Monroe County, New York linked to an unvaccinated toddler with exposures at Canal View Elementery School in Spencerport
1 new case in Clark County, Washington (31 total), with 8 more suspected cases!
3 new cases in Clark County, Washington (34 total), with 9 more suspected cases and exposures in Vancouver (Jan 14 to 23)
1 new case in Clark County, Washington (35 total), with 11 more suspected cases and exposures in Vancouver and Portland (Jan 14 to 23)
1 new case in Clark County, Washington (36 total), with 12 more suspected cases and exposures in Battle Ground (Jan 20)
2 new cases in the Borough Park and Williamsburg sections of Brooklyn (64 total)
an adult in New Haven, Connecticut
another case in Georgia, an unvaccinated family in the metro Atlanta area
6 new cases in Rockland County, New York (128 total)
2 new cases in Clark County, Washington (38 total), with 13 more suspected cases, and exposures in Bend, Oregon (Jan 19-20)
a 4th case in Spencerport, New York, an unvaccinated neighbor of two previous cases.
3 new cases in Clark County, Washington (41 total) with exposures at an after-school activity at Minnehaha Elementary School (Jan 17) triggering exclusion of unvaccinated students and staff, and there are also 15 more suspected cases
1 new case in Clark County, Washington (42 total)
3 new cases in Spencerport, New York (7 total), all unvaccinated.
1 new case in Clark County, Washington (43 total) and 8 more suspected cases
another case at the University of Illinois Champaign-Urbana, another unvaccinated student (2 total)
another case in Connecticut being treated at Yale New Haven Hospital
6 new cases in Clark County, Washington (47 total) and 7 more suspected cases
2 new cases in Clark County, Washington (49 total) and 9 more suspected cases
2 new cases in Rockland County, New York (130 total)
a toddler in Galveston County, Texas that is part of a cluster in the region
3 cases in Harris County, Texas, including two young children and an older woman
a 2-year-old in Montgomery County, Texas that is linked to four other cases.
a case in Bell County, Texas, the 6th in Texas, although it isn’t clear if they are all linked
3 new cases in the Borough Park and Williamsburg sections of Brooklyn (67 total)
a case in Denton County, Texas that is not linked to the 6 other cases in Texas
another case in Clark County, Washington (50 total) and 11 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (52 total)
3 new cases in Multnomah County, Oregon (4 total) that are linked to the Pacific Northwest Measles Outbreak (55 total)
another case in Clark County, Washington (51 total) and 13 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (56 total)
2 new cases in Clark County, Washington (53 total) and 7 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (58 total)
1 new case in Clark County, Washington (53 total) and 2 more suspected cases, all linked to the Pacific Northwest Measles Outbreak (58 total) – a case that was previously confirmed turned out to be a vaccine associated rash, so case count remains the same.
6 new cases in the Borough Park and Williamsburg sections of Brooklyn (73 total)

Almost all of the measles cases in Rockland County are unvaccinated.

5 new cases in Rockland County, New York (135 total) and 3 suspected cases, with almost all cases being unvaccinated (81.5% are unvaccinated)
an unvaccinated child who had traveled out of the country in the Bowling Green area of Kentucky
6 new cases in Clark County, Washington (59 total) and 1 more suspected case, all linked to the Pacific Northwest Measles Outbreak (64 total)
2 new cases in Clark County, Washington (61 total), all linked to the Pacific Northwest Measles Outbreak (66 total)
2 new cases in the Champaign-Urbana Health District in Illinois, another unvaccinated student (4 total)
1 new case in Clark County, Washington (62 total), and a new exposure in Battle Ground (Feb 13), all linked to the Pacific Northwest Measles Outbreak (67 total)
3 new cases in Rockland County, New York (138 total), with almost all cases being unvaccinated (81.5% are unvaccinated)
17 new cases in the Borough Park and Williamsburg sections of Brooklyn (90 total)
1 new case in Clark County, Washington (63 total), and new exposure in Washougal (Feb 14) and Vancouver (Feb 11 and 18), all linked to the Pacific Northwest Measles Outbreak (68 total)
1 new case in Clark County, Washington (64 total), and 2 more suspected cases being investigated, all linked to the Pacific Northwest Measles Outbreak (69 total)
1 new case in Clark County, Washington (65 total), and 1 more suspected case being investigated, all linked to the Pacific Northwest Measles Outbreak (70 total)
1 new case in Rockland County, New York (139 total)
a new case in Bergen County, New Jersey, with exposures in Hillsdale (Feb 17 and 25)
30 new cases in the Borough Park and Williamsburg sections of Brooklyn, plus a case in Queens (121 total)
a case in Illinois, a resident who exposed others when their flight arrived in Concourse B at Chicago Midway Airport on Feb 22 and at Northwestern Medicine Delnor Hospital on Feb 24
3 new cases in Clark County, Washington (68 total), and 3 more suspected case being investigated, all linked to the Pacific Northwest Measles Outbreak (73 total)
1 new case in Rockland County, New York (140 total)
2 new cases in Multonmah County, Oregon that are not linked to the Pacific Northwest measles outbreak
2 new cases in Clark County, Washington (70 total) and a new exposure in Vancouver (March 1 and 2), all linked to the Pacific Northwest Measles Outbreak (75 total)
a passenger from New York City who exposed people on a Greyhound Bus as they traveled to Boston and Manchester, New Hampshire while contagious on Feb 26
3 new cases in Rockland County, New York (143 total)
12 new cases in the Williamsburg and Brighton Beach sections of Brooklyn (133 total)
a case in San Francisco, California – an adult who was exposed during an international flight
a case in San Antonio, Texas

a new case in Rockland County, New York (144 total)
another case in California related to a sick passenger on a plane
a 1-year-old in Pima County, Arizona who had traveled to Asia
an out-of-state traveler to Jefferson County, Missouri
a case in Collin County, Texas
a new case in Rockland County, New York (145 total)
25 new cases in the Borough Park, Midwood/Marine Park, and Williamsburg sections of Brooklyn (158 total)
a case in Marion County, Oregon that isn’t related to their current outbreak
1 new case in Clark County, Washington (72 total), linked to the Pacific Northwest Measles Outbreak (76 total)
a travel related case in Oakland County, Michigan with exposures in Oak Park and Southfield (March 6 to 13)
2 cases in Liberty, New York (Sullivan County) with probable ties to the outbreak in Brooklyn
2 new cases in Rockland County, New York (147 total)

There are now 147 measles cases in Rockland County.

a new case in Lakewood, New Jersey – remember that Ocean County was the site of a big outbreak last year (33 cases)… (March 9 and 14)
an internationally imported case of measles in Clark County, Nevada, with exposures at a hospital and the Treasure Island Hotel and Casino in Las Vegas (March 9 and 11)
a new case in Collin County, Texas, with exposures at a Kroger in Prosper
1 new case in Clark County, Washington (73 total), linked to the Pacific Northwest Measles Outbreak (77 total)
23 new cases in the Borough Park and Williamsburg sections of Brooklyn (181 total)
2 new cases in Rockland County, New York (149 total)
a 4th case in Ocean County, New Jersey with exposures in Lakewood (March 9 and 14)
2 new cases in Rockland County, New York (151 total)
a case in Tarrant County, Texas
another case in San Antonio, Texas (2 total)
4 more cases in Oakland County, Michigan (5 total), with 3 more cases under investigation and exposures in Oak Park, Southfield, and Berkley (March 14 to 19)
a child in Calaveras Springs, California
three new cases in Oakland County, Michigan (8 total)
two unvaccinated adults in Butte County, California and a related case in Shasta County, with exposures in Chico and Redding
10 new cases in Oakland County, Michigan (18 total), with exposures in Berkley, Oak Park, West Bloomfield, Southfield, and Royal Oak

Rockland county executive Ed Day declared a local state of emergency over the ongoing measles outbreaks in the area on March 26.

2 new cases in Rockland County, New York (153 total)
4 new cases in Oakland and Wayne counties in Michigan (22 total) with new exposures in Pontiac and Southfield
33 new cases in the Borough Park, Williamsburg, and Midwood/Marine Park sections of Brooklyn (214 total)
a new case in Santa Clara, California, with exposures in Sunnyvale, San Jose, Cupertino, Stanford, Palo Alto, Mountain View, Santa Clara, and Milpitas (March 16 to 22)
a new case in Alameda County, California with exposures in Livermore (March 23)
a new case (an out-of-state visitor) in Indianapolis, Indiana
a new case in Broward County, Florida
3 new cases in Placer County, California with exposures in Auburn (March 18)

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:

VAXOPEDIA – The Pacific Northwest Measles Outbreak of 2019
VAXOPEDIA – Is January Usually a Big Measles Month?
VAXOPEDIA – How Contagious Is Measles?
VAXOPEDIA – Why Do We Only Worry About Measles?
VAXOPEDIA – What to Do If Your Child Is Exposed to Measles
VAXOPEDIA – The Myth That Measles Isn’t Deadly
VAXOPEDIA – Can MMR Shedding Start a Measles Outbreak?
VAXOPEDIA – Who Dies with Measles?
VAXOPEDIA – Does Having Measles Protect You from Cancer?
VAXOPEDIA – A History of Measles Outbreaks in United States
VAXOPEDIA – Measles Deaths in Italy
VAXOPEDIA – Measles Deaths in the 21st Century
VAXOPEDIA – About Those Measles Outbreaks in China
VAXOPEDIA – When Was the Last Measles Death in the United States?
VAXOPEDIA – Costs of a Measles Outbreak
CDC – Measles Cases and Outbreaks
Measles – Timeline | History of Vaccines
Ask the Experts about MMR
Measles outbreak in Washington State 2019
Pacific Northwest Measles Outbreak Winter 2019
California Department of Public Health
The Number of Measles Cases Grows to 390

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.	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? Photo by Petrus Rudolf de Jong (CC BY 3.0)	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. Photo by Jim Goodson, M.P.H.	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. (CC BY-NC-SA)	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.	Chronic hepatitis B is a silent killer.
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 meningococcal disease.
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 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, 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. (CC by 3.0)
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.
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.
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.

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…

Measles Returns to California

Breaking News – There are now six cases of measles in the San Francisco Bay Area, all unvaccinated, in an ongoing outbreak that has also spread to Nevada.

There are now six cases of measles in the San Francisco Bay Area as the outbreak grows.

Is anyone surprised that a student in California has measles?

Actually, a lot of folks are probably surprised. After all, didn’t lawmakers in California recently pass a law that mandated everyone in school get vaccinated?

Well yeah, but SB277 didn’t apply to all students. Only new students and those transitioning to a new grade span (for example, moving from K-6th to 7th grade) have to meet the new minimum immunization requirements. That means it will take more than a few years until all of the kids already in school whose parents have skipped or delayed any vaccines have gotten caught up or have graduated.

And that means we will still see some of these outbreaks of vaccine preventable diseases.

There is also a little issue with medical exemptions somehow rising being abused after the personal belief exemption was eliminated in the state…

Measles Outbreaks in California

When you think of measles and California, most people probably think of the 2015 Disneyland outbreak, which was linked to:

134 cases in California, including at least 50 cases without a known source
13 cases in Arizona, Nebraska, Utah, Colorado, Washington, and Oregon
1 case in Mexico
159 cases in Canada

The Disneyland outbreak included a lot of intentionally unvaccinated kids and kept unvaccinated kids from school, closed daycare centers, and led to hospitalizations of more than a few people.

“The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents.”

Majumder et al. on Substandard Vaccination Compliance and the 2015 Measles Outbreak

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.

The Disneyland outbreak wasn’t the first big measles outbreak in California in recent years though.

No, I’m not talking about the really big outbreaks from the pre-vaccine era. Or even the outbreaks in the late 1980s, just before we started giving an MMR booster. Believe it or not, 75 people died between 1988 and 1990 with measles – just in California.

More recently, there was the 2008 outbreak in San Diego that was triggered by an unvaccinated 7-year-old boy who had traveled to Switzerland with his family.

He returned with measles and got at least 10 other unvaccinated children sick, including four infants who were too young to be vaccinated and were unknowingly exposed at their pediatrician’s office.

“Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears…”

OC’s Dr. Bob Sears discusses measles outbreak on NPR

One of those infants was hospitalized when his fever spiked to 106 degrees and he wouldn’t eat or drink.

“We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately.”

Megan Campbell on 106 Degrees: A True Story

Measles cases also began rising in 2011, as unvaccinated travelers brought measles back from trips to Europe, Asia, and Africa, where there were large outbreaks. There were 31 measles cases in California in 2011.

While 31 cases might not seem like much, consider that between 2001 through 2006, there were just 66 cases in California, with only 4 cases in 2005!

Will we ever get to a year with just 4 cases in California again?

It didn’t happen in 2017.

Last year started with a big outbreak in Los Angeles County that grew to include at least 24 cases and a few surrounding counties. There was also a case involving an unvaccinated student at Laguna Beach High in Orange County which led to the quarantine of at least 6 unvaccinated students.

The Latest California Measles Outbreak

What kind of a measles year will we see in 2018 in California?

There is just one case, so far.

Well, it was just one case. There are six cases now… Seven if you count the linked case in Nevada.

Did you eat lunch at the Westgate Center food court on Friday, March 2?

It started when an unvaccinated student returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County at a school in Campbell and at the Westgate Center food court in San Jose.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. — The measles rash begins 3-5 days after other measles symptoms, which is why measles is often hard to diagnose.

With an average incubation period of 10 to 12 days, that means exposed people might begin to show symptoms by March 14. Keep in mind that the incubation period can be as long as 21 days though, so be on the watch for measles symptoms until at least March 23 if you could have been exposed.

Since we don’t know when the new cases began to show symptoms, it is hard to know how much longer we can expect to see new cases. Hopefully these folks were already in quarantine and didn’t expose anyone else.

Would you recognize measles?

It is important to understand that the first symptoms of measles don’t include a rash. Instead, you get a high fever, runny nose, cough, and pink eye. The measles rash comes a few days later, as the high fever continues.

It is also important to understand the the MMR vaccine is safe and works very well to prevent measles.

This exposure is a great reminder that vaccines are necessary and that you shouldn’t wait for your kids to get exposed to get them caught up and vaccinated and protected.

What to Know About Measles Outbreaks in California

A recent outbreak of measles in California, this time in Santa Clara County, is a good reminder that the MMR vaccine is necessary to keep your kids protected.

More on Measles Outbreaks in California

Updated April 7, 2018

VAXOPEDIA

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