Tag: post-exposure prophylaxis

Jim Meehan Supporting a Farmer Helps Explain the Deaths in Samoa

In case you need to be caught up, there is a measles epidemic in Samoa and over 50 kids have already died.

While that easily dwarfs the number of deaths in many other countries, where there have been thousands of deaths, Samoa has been getting some extra attention because some of the blame rests with anti-vax influence on the island nation.

Taylor Winterstein compared the plan to vaccinate everyone against measles to stop the outbreak to Nazi Germany!

Samoa even got a visit from Bobby Kennedy last June!

Jim Meehan Supporting a Farmer Helps Explain the Deaths in Samoa

It is even more amazing that many of these folks have been doubling down on their anti-vax activism even as measles deaths have continued to climb.

Edwin Tamasese is an holistic healer in Samoa.
I wonder what Jim Meehan thinks caused those birth defects in Brazil…

It seems that Edwin Tamasese, a farmer in Samoa who is also described as a holistic healer, is being advised on how to treat kids with measles by James Meehan, an ophthalmologist in Oklahoma who now practices integrative and functional medicine.

How do either have the training or background to help sick kids in a measles epidemic?

That they don’t is easy to see from Meehan’s letter of support…

The last thing folks in Samoa need is advice from Jim Meehan!
The last thing folks in Samoa need is advice from Jim Meehan!

Wait, why would anyone vaccinate a child who was already infected with measles?

Probably because it is a part of routine measles postexposure prophylaxis guidelines. In fact, giving a dose of MMR within a few days of exposure to someone with measles can reduce their risk of getting sick with measles or of developing complications of measles.

Of course, you wouldn’t actually give the MMR vaccine to someone who was already sick with measles though. Instead of simply being infected with measles, that would be someone with measles disease.

Big difference!

Antibiotics don't treat viral infections, but they do treat secondary bacterial diseases and superinfections that often complicate measles infections.

There are no indications for antibiotics to treat uncomplicated viral diseases, unfortunately, secondary bacterial diseases can occur and do need to be treated.

“These results document that MV infection can suppress both innate and adaptive immune responses and lead to increased susceptibility to bacterial infection.”

Slifka et al on Measles virus infection results in suppression of both innate and adaptive immune responses to secondary bacterial infection

In fact, it is these secondary bacterial super-infections, including pneumonia and mastoiditis, that can make measles so deadly.

“Mortality from measles is predominantly caused by complicating bacterial infections.”

Factsheet about measles

It is a big reason that kids with measles, a viral infection, likely need to be treated with antibiotics.

It is typically only recommended that parents treat fever if their child is very uncomfortable.
It is typically only recommended that parents treat fever if their child is very uncomfortable.

Kids with measles typically have a high fever and are very irritable.

While we have been moving towards an approach of letting fevers run their course these days, in case fever does have some beneficial effects, there are also studies that have shown that in critically ill patients, fever is associated with increased mortality.

Measles is not mutating.
Mutating measles? Where have we heard that before?

Why do we genotype measles strains?

So that we know where outbreaks originated from.

Unlike some other infections, the genotype doesn’t help you figure out whether or not the vaccine will work against it. Measles is a monotypic virus. The MMR vaccine protects against all measles strains.

“The outbreaks in Samoa and Tonga are caused by the D8 strain (genotype) of measles virus.”

Measles Outbreak in the Pacific – Situation Report No 2, 26 November 2019

An no, for the millionth time, 38% of the measles cases in the Disneyland outbreak were not caused by the vaccine strain!

Those folks with the vaccine strain were the ones who were recently vaccinated and had a “febrile rash illness,” a common side effect of the vaccine.

They did not have measles!

While vaccinating someone who is truly immunosuppressed with a live vaccine is contraindicated, it seems like Meehan thinks that most of the folks on Samoa are immunosuppressed and shouldn’t be vaccinated!

The kids are dying because they aren't vaccinated and protected!
Not the measles virus??? The kids are dying because they aren’t vaccinated and protected!

There is a state of emergency in Samoa that has closed schools, banned public gatherings, and mandated vaccines, as they attempt to get their measles epidemic under control. They are also getting help from UNICEF, the New Zealand Red Cross, UK’s Emergency Medical Team (UK EMT), the Australian Medical Assistance Team (AUSMAT), and the New Zealand Medical Assistance Team (NZMAT).

More help is coming from the CDC and the EUCPM.

How much vitamin C are the kids on Tamasese's protocol getting?
How much vitamin C are these kids getting? 3000mg? 5000mg? Since too much vitamin C causes diarrhea and nausea, how much will they take “until stomach runs?” Diarrhea and dehydration are already complications of measles…

They do not need folks like Tamasese and Meehan interfering with these efforts because they think they can do it better, even as they scare parents away from vaccinating and protecting their kids – the one thing that will end the epidemic.

It should be noted that as much as anti-vax folks are crowing about Tamasese and Meehan’s efforts to get kids vitamin A, their protocol severely under doses kids!

The WHO has a protocol for giving kids high doses of vitamin A when they have measles.
The WHO has a protocol for giving kids high doses of vitamin A when they have measles.

Anyway, mega doses of vitamin A are most helpful in reducing mortality in hospitalized kids with measles. It is also important to keep in mind that vitamin A only reduces mortality – it doesn’t eliminate it. Vitamin A is not a cure for measles.

And the mega doses of vitamin C they are giving aren’t going to help prevent complications. They are just giving the kids diarrhea, which is not a good thing if they might already be malnourished!

What’s the biggest takeaway from the Samoa epidemic?

As we see more measles, we will see more people die with measles.

Measles is deadly.

This type of anti-vax propaganda is the reason that parents might think that vaccines are toxic...
This type of anti-vax propaganda is the reason that parents might think that vaccines are toxic…

Get vaccinated and protected with two doses of MMR and prevent these outbreaks.

More on Jim Meehan and Samoa

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

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

How to Avoid Getting Caught up in a Measles Outbreak

By now, you have likely heard the news that we are on track for record-breaking numbers of measles cases this year, both in the United States and around the world.

You may also have heard that some of the folks getting caught up in these outbreaks weren’t actually anti-vaccine, but were people who thought they already had measles or thought they were already vaccinated and protected.

How to Avoid Getting Caught up in a Measles Outbreak

Are you and your family protected against measles?

Six ways to avoid measles.

You might be thinking, “of course we are, we get all of our vaccines!”

But you still might want to double check, keeping in mind that:

  • only people born before 1957 are thought to have natural immunity to measles, because measles was very common in the pre-vaccine era
  • the original measles vaccine that was used between 1963 and 1967 was not thought to be effective, so if that’s the only dose you had, it should be repeated
  • a recommendation for a second dose of MMR didn’t come until 1990, so many people born before that time have only had one dose, especially since there was never a catch-up program to make sure older people had two doses. Even now, adults don’t necessarily need two doses of MMR unless they are in a high-risk group (foreign travel, healthcare workers, living with someone who has a compromised immune system, people with HIV, and students).
  • children don’t routinely get their first dose of MMR until they are 12 to 15 months old (one dose is 93% effective at preventing measles), with a second dose at age 4 to 6 years (two doses are 97% effective)
  • a third dose of MMR isn’t typically recommended for measles protection

Still think you and your family are protected?

In addition to routine recommendations, to avoid measles in a more high risk setting (traveling out of the country or during an outbreak), you should:

  • get infants an early MMR, giving them their first dose any time between 6 and 11 months of age (repeating this dose at age 12 to 15 months)
  • get toddlers and preschoolers an early second dose of MMR, giving them their second dose at least 28 days after the routine first dose that they received when they were 12 to 15 months old, instead of waiting until they are 4 to 6 years
  • get older children and adults two doses of MMR if they haven’t already had both doses

What if your baby is exposed to measles before you have a chance to get him vaccinated?

Younger infants who are less than six months old can get a dose of immunoglobulin within 6 days if they are exposed to measles. Older infants, children, and adults can get a dose of MMR within 72 hours if they are not vaccinated and are exposed to someone with measles.

And the very best way to avoid measles is to keep up herd immunity levels of protection in our communities. If everyone is vaccinated and protected, then we won’t have outbreaks and our kids won’t get exposed to measles!

More on Avoiding Measles