Tag: MMR rash

Vaccine Induced Measles

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

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.

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.

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?

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.

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.

What Is Your Protocol to Stop Measles Before Kids in Your Office Get Exposed?

Measles outbreaks have reached record levels this year. Unless you’re prepared, with a strict protocol to stop measles, that could mean that someone could get exposed in your office.

“Many of today’s physicians may never have seen a patient with measles— a disease that can cause serious complications in infants, young children, and adults. CDC is urging all physicians to “think measles” when evaluating patients who have fever and rash, and to know what to do to prevent, control, and report measles cases.”
CDC Asking Physicians to “Think Measles” and Help Stop the Spread

Have you ever seen a child with measles?

What Is Your Protocol to Stop Measles Before Kids in Your Office Get Exposed?

To help everyone understand how important it is to think about measles and prevent unnecessary exposures, it can help to understand what happens when a child with measles does go to their pediatrician, an urgent care center, or the ER.

Part of your protocol to stop measles will be making sure th unvaccinated children exposed to measles are quarantined for at least 21 days. — Unvaccinated children exposed to measles are quarantined for at least 21 days.

Since measles is so contagious and can remain infectious for up to two hours after a person has left a room, with each measles case, you will have to:

isolate the person with measles (or suspected measles) in a negative pressure isolation room. If that’s not possible, at least have the person wear a mask in their own private room and/or schedule them at the end of the day, bypassing the waiting room. You might even go out to their car for a quick interview and exam before they come into the office.
not use that exam room for at least two hours after the person with measles leaves.
report the case to your local health department ASAP, as they will likely have more extra resources to help you manage your patient.
locate everyone who could have been exposed, including anyone who was in the same area as the suspected case or entered the area over the next two hours. If they aren’t already immune, these folks might need immune globulin (younger than six months or immunocompromised) or a dose of MMR. They will probably also be quarantined to make sure they don’t develop measles and expose others.
only allow those who are immune to measles (two doses of MMR or natural immunity) to take care of the suspected case. Everyone should still wear an N95 respirator or at the very least, a general facemask, just in case.
limit anyone else’s exposure as you work to confirm that they have measles (PCR testing of throat swab and urine), provide supportive care as necessary, or quarantine them at home.

Unfortunately, it usually ends up being more than a single exam room that has to be closed when a child shows up with measles. After all, before they got to that exam room, they were probably in the waiting room and other general areas of the office.

And that’s why you will want to have a protocol in place to avoid or minimize these exposures.

Don’t Spread Measles

Of course, that starts with trying to get everyone vaccinated and protected, including an early dose of MMR when appropriate, so that your patients don’t get measles in the first place!

“Failure to promptly identify and appropriately isolate measles cases has led to the investigation of hundreds of healthcare contacts this year. Measles transmission has occurred in emergency departments and other healthcare settings, including transmission to one healthcare worker.”
Recommendations for Measles Case Identification, Measles Infection Control, and Measles Case and Contact Investigations

Next, make sure everyone understands how to recognize the signs and symptoms of measles. Otherwise, some of these kids might unexpectedly end up in your office when they are sick.

The classic measles rash, which begins on the face, typically doesn't begin until these kids have had fever for two or three days. — The classic measles rash, which begins on the face, typically doesn’t begin until these kids have had fever for two or three days. Photo by Jim Goodson, M.P.H.

Think that’s easy? You just watch out for kids with a fever and a rash, right?

Wrong.

If you wait until they have the classic measles rash, you will likely miss the diagnosis the first time they come to your office. Remember, the rash typically doesn’t show up until they have already had a fever for three or four days.

Unfortunately, these kids are contagious well before they have a rash. They are even contagious before they have a fever and know they are sick.

As part of your protocol to stop measles, post a warning sign before parents come into your office.

So you should suspect measles in kids:

with a high fever and cough, coryza, and conjunctivits, even if they don’t yet have a rash
with classic measles symptoms who have had a possible exposure. This includes kids who recently traveled out of the country (get a travel history), had contact with international travelers, or just because there are a lot of cases in your area.
who are unvaccinated or not completely vaccinated, with two doses of MMR. Keep in mind that even fully vaccinated kids can sometimes get measles though.

And then, if you suspect that a child has measles, work to limit their exposure to others. Patients should know to call ahead. Staff at your office, lab, or the ER should be alerted and ready to see anyone with suspected measles. That way the family knows to wear a mask before going inside.

Ideally, if you have a strong suspicion that the child has measles, this visit will occur in a facility with a negative pressure airborne infection isolation room.

What’s the problem with this kind of protocol?

Lots of kids have fever and rashes! And since you can’t send everyone that calls with adenovirus, roseola, or hand, foot and mouth disease to the ER, part of your protocol should likely be that a health care professional carefully assesses the child’s signs, symptoms, and risks for measles before deciding what to do.

Mostly, be suspicious if a child has returned from a trip oversees, especially if they are unvaccinated, and they have a febrile illness.

More on Your Protocol to Stop Measles Before Kids in Your Office Get Exposed

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.

VAXOPEDIA