Tag: MMR vaccine

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.

How Many People Have Died from Measles in 2019?

As measles cases climb, some folks are interested in just one thing, how many people have died from measles this year?

**A lot of people are dying from measles this year.**

The rest of us?

We understand that as we see more and more cases, it simply increases the chances that someone might eventually die.

How Many People Have Died from Measles in 2019?

So far, we have been very lucky that there have been no measles deaths, even as we pass 1,000 cases.

Not that 1,000 cases is some magic number where you start to see deaths.

Consider that we only had 188 cases in 2015, when we had the last measles death in the United States. That year, a woman got caught up in a small outbreak in Washington.

Where Are People Dying of Measles in 2019?

There are also many countries with rather small numbers of cases that are seeing measles deaths.

The last death in France, in April 2019, occurred after only 852 cases were reported.

In Romania, the first death of 2019, in January, came after just 133 cases.

Measles acts quickly. Do your part to protect yourself and others.

And since the outbreaks in Europe started in 2016, there have been deaths in:

Bulgaria – only 416 cases
Portugal – only 202 cases
Spain – only 457 cases
Switzerland – two deaths and only 197 cases!

Of course, there are more deaths in countries that are seeing more cases.

Again, since 2016:

Country	Deaths	Cases
Romania	59	17,850
Greece	4	3,270
Italy	13	9,277
France	4	4,138
UK	1	2,000
Germany	1	2,000
Israel	2	4,256 (since 2018)
Ukraine	17	52,034 (2019)
Serbia	15	5,797 (since Oct 2017)
Brazil	12	19,036 (since 2018)
Tunisia	30	3,141 (2019)
Malaysia	6	2,129 (since 2017)
Thailand	23	5,893 (since 2018)
Guinea	14	1,359 cases (2019)

And a lot more deaths in some countries:

Madagascar – at least 1,233 reported deaths among 122,840 registered cases
Philippines – at least 389 deaths in 2019, with over 30,000 cases.
Venezuela – at least 134 deaths since 2017, with over 9,585 cases
Democratic Republic of Congo – at least 1,460 deaths this year, with over 84,000 cases
Nigeria – at least 89 deaths this year, with nearly 29,000 cases
Chad – at least 191 deaths this year, with over 18,000 cases

Measles is on the rise.

Measles deaths are on the rise too. While the risk of complications of measles can be reduced with vitamin A treatment, that doesn’t eliminate them. And the benefit is mostly in those who are already vitamin A deficient. Vitamin A has a much more modest effect in developed countries, where measles deaths still occur.

What to reduce your child’s risk of dying from measles?

Get them vaccinated and protected.

Tragically, this all comes after we were making progress towards measles elimination, reaching a record low for global cases and deaths just a few years ago.

How will we respond? An even stronger effort to finally get measles under control? Or continued worsening, with more cases and more deaths?

When Do You Get the Measles Vaccine?

With the rise in measles cases this year, folks are asking when they routinely get the measles vaccine to help make sure they are vaccinated and protected.

Do you know when you routinely get your measles vaccine? — Adults who aren’t high risk might be able to get away with simply having one dose of MMR or a measles containing vaccine since 1967.

Unfortunately, there isn’t an easy answer.

When Do You Get the Measles Vaccine?

Well, there kind of is.

Today, we routinely give:

the first dose of the measles vaccine (MMR) when toddlers are 12 to 15 months old, and
the second dose of MMR when they are 4 to 6 years old

However, if you are at high risk to get measles, especially if you are planning to travel out of the country or to specific areas with active outbreaks, you should get those doses early.

Early Doses of MMR

How early?

As early as age six months.

In fact, high-risk infants 6 through 11 months of age should receive one early dose of MMR vaccine, a dose that will have to be repeated when they are 12 months old. This early dose is mostly about international travel though and not travel within the United States, unless there is a specific recommendation in a local area.

“For outbreaks with sustained, community-wide transmission affecting infants <12 months of age and with ongoing risk of exposures to infants, health departments may consider vaccination of infants aged 6-11 months in these affected areas (including visitors) with 1 dose of MMR vaccine. This recommendation should be made following careful assessment of the benefit of early protection against measles during a period of increased transmission and exposure, and risk of decreased immune response following subsequent MMR doses in infants vaccinated at <12 months of age compared with infants vaccinated at ≥12 months of age.”
Manual for the Surveillance of Vaccine-Preventable Diseases

And children 1 to 3 years of age who are high-risk should receive two doses of MMR vaccine (instead of waiting to get the second dose when they are 4-6 years old), separated by at least 28 days.

This second dose doesn’t have to be repeated though.

When Did We Use to Give the Measles Vaccine?

Still, more than a review of the current immunization schedule, most folks want to know when we used to get vaccinated against measles. That’s what might help you figure out if you are vaccinated and protected.

Hopefully, you can just check your shot records too.

It might also help to know that we began:

giving the first measles vaccine in 1963. This doesn’t count as a dose of measles vaccine though, as it didn’t provide long-lasting protection.
giving the first improved, live measles vaccine in 1967.
using the combined MMR in 1971.
offering a second dose of MMR to kids in 1990.

So, how many doses have you had?

What to Know About Getting an MMR Vaccine

If you haven’t had two doses and are at high risk to get measles, get caught up and protected. Keep in mind that you don’t need to check your titers first and you won’t need a third dose of MMR. Titers might be a good idea if you were born before 1957 and aren’t sure if you had a natural case of measles.

“The best way to protect yourself and your loved ones from measles is by getting vaccinated. You should plan to be fully vaccinated at least 2 weeks before you depart. If your trip is less than 2 weeks away and you’re not protected against measles, you should still get a dose of MMR vaccine.”
Before international travel: Make sure you’re protected against measles

Lastly, if possible, try to get your second dose of MMR at least two weeks before your trip.

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.

VAXOPEDIA

How Many People Have Died from Measles in 2019?

How Many People Have Died from Measles in 2019?

Where Are People Dying of Measles in 2019?

More on How Many People Have Died from Measles in 2019

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