Tag: travel

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

We Know What Happens If We Stop Vaccinating

It’s no surprise.

If we stop vaccinating, diseases that are now vaccine preventable will come back.

How do we know?

Because it has happened already.

We Know What Happens If We Stop Vaccinating

It has happened a lot, actually.

Remember when Sweden stopped using the DPT vaccine?

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

Justus Ström‘s data was wrong…

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”

Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”

Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time. All of the claims against the whole cell pertussis vaccine ended up being untrue.

The same thing happened when Japan stopped using the MMR vaccine.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

What happened in Ukraine when immunization rates dropped in the 1990s? There were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Remember the measles outbreaks that spread across Europe in 2010 to 11, leading to about 30,000 cases of measles each year, and at least 28 deaths?

That should have been enough to warn folks, but it didn’t.

Things are much worse now, with over 120 measles deaths in Europe over the past few years.

More recently, in Venezuela, shortages of most things have led to ongoing epidemics of measles and diphtheria, a “potential for reemergence of poliomyelitis,” and a risk to neighboring countries.

“Officials say the low coverage rate and widespread transmission of the virus is due to many factors, including transport costs for those in rural areas, a high number of people with weakened immune systems, such people living with HIV and tuberculosis – and vaccine refusal.”

Ukraine: Red Cross deployed to help contain largest measles outbreak in Europe in four years

And once again, there are measles outbreaks in Ukraine. This time, they have spread to many other countries, fueling outbreaks in Israel and the United States.

We know what happens if we stop vaccinating. Get vaccinated and stop the outbreaks.

Vaccines are safe, with few risks, and are very obviously necessary.

More on What Happens If We Stop Vaccinating

Timeline of the Measles Outbreak in Brooklyn

Breaking News – there are 30 new cases in Brooklyn, as a judge upholds the order, and 3 parents face penalties (see below).

There have been several big outbreaks of measles in the United States this year, but until recently, the biggest hadn’t gotten much attention.

As the outbreak in Brooklyn kept getting bigger and bigger, most people focused on the outbreaks in Clark County, Washington and Rockland County, New York.

Timeline of the Measles Outbreak in Brooklyn

Of course, with the emergency order in Brooklyn, the focus is now shifting.

So what do we now about the Brooklyn measles outbreak?

  • the outbreak began in October 2018 and was started by a traveler returning from Israel, where there is a large outbreak
  • as of early April, there have been 285 cases (we rarely see that many cases in an entire year, even when combining all of the cases in the whole country!)
  • most cases are in the Orthodox Jewish community, even though this is not a religious issue, except that this community has been targeted by an antivaccine group
  • 246 cases have been in children
  • the youngest case was an infant who was only 4 weeks old!
  • 21 people have been hospitalized
  • 5 have been admitted to the ICU!

What else do we know?

Although the outbreak is in its 5th month, which is very long for a measles outbreak in the post-vaccine era, there have been 152 new cases in just the past month!

There were 133 measles cases in Brooklyn in early March.

So at a time when cases should have already stopped (most outbreaks only last a few months), or at least be decreasing, the Brooklyn outbreak has more than doubled in size!

There have been 285 cases of measles in the Brooklyn outbreak.

There is no sign of it stopping either, with news reports of more than 20 to 40 cases each week.

And that’s what brought on the April 9 declaration of an emergency order.

“IT IS HEREBY ORDERED that any person who lives, works or resides within the 11205, 11206, 11221 and/or 11237 zip codes and who has not received the MMR vaccine within forty eight (48) hours of this Order being signed by me shall be vaccinated against measles unless such person can demonstrate immunity to the disease or document to the satisfaction of the Department that he or she should be medically exempt from this requirement. “

ORDER OF THE COMMISSIONER to All persons who reside, work or attend school in the neighborhood of Williamsburg, Brooklyn, New York and to the parents and/or guardians of any child who resides, works or attends school in the neighborhood of Williamsburg, Brooklyn, New York

Does this mean that they will be forcing everyone in Williamsburg to get vaccinated? And arresting those that don’t?

“I want to do the common sense point. We are trying to get people vaccinated. Our goal is not to find anyone. Our goal is not to shut down schools. Our goal is to get people vaccinated.”

Mayor Bill De Blasio

It should be clear that they are just trying to end the outbreak.

“People in violation of the order will be identified through identification of exposures. Disease detectives will check for immunization status or immunity when tracing the contacts of a person who has developed the illness. “

Oxiris Barbot, M.D. Commissioner of Health

And no one will be forced to get a vaccine. You might be fined if you insist on not getting vaccinated and you have been exposed to someone with measles, but you still won’t be forced to get the vaccine.

Why did it come to this?

Couldn’t they just quarantine folks who are exposed?

Well, they have been trying that…

And it hasn’t been working.

Williamsburg press conference with NYC Mayor Bill De Blasio, with Herminia Palacio, MD, NYC Deputy Mayor of Health and Human Services, and Oxiris Barbot, MD, NYC Commissioner of Health
Williamsburg press conference with NYC Mayor Bill De Blasio, with Herminia Palacio, MD, NYC Deputy Mayor of Health and Human Services, and Oxiris Barbot, MD, NYC Commissioner of Health

In addition to schools continuing to let in unvaccinated students, the health department is concerned that people in the community might actually be having measles parties!

“So we have not used a public health emergency to mandate vaccine in recent history. The circumstance of the combination of a large anti-vax movement in combination with a large outbreak has not happened in the way that it has happened right now.”

Dr. Herminia Palacio, NYC Deputy Mayor of Health and Human Services

As in Rockland, there is also an aggressive anti-vaccine campaign in Brooklyn that is pushing misinformation and is scaring parents away from vaccinating their kids.

30 new cases this week

If you are upset that this is happening in Brooklyn, the outbreaks and the response to the outbreaks, the anti-vaccine groups working in the community are to blame.

Vaccines are safe, with few risks, and are very obviously necessary.

Get vaccinated. Stop the outbreaks.

Timeline of the Measles Outbreak in Brooklyn

Updated April 18, 2019

Japan’s Rubella Outbreak Should Be a Warning About What Could Happen Here

Do you remember when we used to have rubella outbreaks in the United States?

There is a level 2 travel alert for Japan because of outbreaks of rubella.

Yeah, me neither, but in the rubella epidemics of the 1960s, rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome.

Japan’s Rubella Outbreak

Thanks to the rubella vaccine, the ‘R’ in the MMR, we rarely hear about rubella anymore.

Tragically, like measles and other vaccine-preventable diseases, rubella is coming back.

RubellaCongenital Rubella Syndrome
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There are still relatively few cases, but most of us would like to keep it that way.

The US had a big spike in rubella cases in the last 1980s.

We remember that with the return of measles in the late 1980s, rubella came back right along with it, causing 13 deaths and 77 cases of congenital rubella syndrome!

And that’s what is happening in many countries right now.

In Japan, for example, in addition to a rise in measles cases this year, they are seeing big outbreaks of rubella, with weekly totals exceeding 100 cases! These are numbers that are close to what they saw during outbreaks in 2013, a year that ended with 14,344 cases of rubella and 32 cases of congenital rubella syndrome.

Japan is on track to have a big rubella year.
Japan is on track to have a big rubella year.

And they are already reporting at least one case of congenital rubella syndrome, a 4 week old, which is not surprising, considering that they had nearly 3,000 cases of rubella last year.

A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.
A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.

Is that what we want to happen here too? Are folks looking forward to having to worry about babies being born with congenital rubella syndrome, a vaccine-preventable disease?

A vaccine-preventable disease that was declared eliminated in the United States in 2004.

More on Japan’s Rubella Outbreak

Measles in Iceland

Have you ever played the game Plague Inc?

If you have, you know it is really hard to infect Iceland!

“An 11-month-old child was diagnosed with measles last weekend. The virus is thought to have entered into the country via a person that came to Iceland from the Philippines last February 14 on an Icelandair flight, the Directorate of Health has stated.”

Eleven Month Old Child Infected by Measles

Not so much in real life…

Measles in Iceland

With the rise of measles cases in so many places in the world, it appears that even Iceland isn’t immune to the virus.

All it takes is someone with measles getting on a plane:

“Since 2016, measles cases have repeatedly occurred on board aircraft passing through Iceland. The first such case occurred on board an Icelandair plane in August 2016 in a child in transit in Iceland on its way from Canada to England. One unvaccinated Icelander on the same plane became ill of measles.

In the spring of 2017, a nine-month-old child became ill after returning to Iceland from Thailand. The baby’s twin brother became ill of measles two weeks later in Iceland. The brothers were unvaccinated because of their young age. By the end of October 2017, an Icelandic resident who had been staying in Bangladesh became ill with mild symptoms after returning to Iceland. He had a history of adequate vaccination against measles and the antibody response was potent, leading to mild non-characteristic morbidity syndrome.

In May of this year, a case of measles was confirmed on board an Icelandair plane flying from Germany to Canada with a transit in Iceland and again, in July, in an individual travelling from England to the United States with WOW air, also transiting in Iceland. No Icelanders became infected in these airplanes.”

EPI-ICE. October 2018

Why aren’t even more cases of measles in Iceland?

Most folks in Iceland are vaccinated and protected!

They likely need to do a better job of getting kids an early MMR if they are going to be traveling out of the country though.

More on Measles in Iceland