Measles Epidemic Update- February 7, 2015 2:50 PM: How to Protect Your Child

Measles Epidemic Update- February 7, 2015 2:50 PM:  
How to Protect Your Child

The measles epidemic that started late in 2014 at Disneyland, California, continues to spread.

As of the last CDC update on January 30, 2015, there have been 102 documented cases of measles in the United States, across 14 states, including Illinois and Michigan, in just 2015.

There are no cases of measles known to have been seen in Ohio in 2015 so far.

Most of the 102 cases in the US this year are from the initial cases seen at Disneyland, California.

What is the Threat to Your Child?  (Spoiler Alert- not much)

The level of danger is actually incredibly tiny.  One could also say it is remote.  

You might ask, how can that be, the US is in the grip of a historic measles epidemic.  But keep in mind, an epidemic is a run of infections that exceed expected incidence.  The expected incidence in the US is 0.  In the year 2000, measles was declared eradicated. No measles cases occurred in the US from 2000-2007.

So, any group of cases is an epidemic.  

It turns out that this current outbreak, with 102 cases in January, makes the rate of measles quite tiny, about 100 out of every 300 million Americans got it it, or 1 in 3 million people.

Personally, if a threat is facing me, I prefer the chances of it happening to me be about 1 in to 3 million  rather than say 1 in 10 or even 1 in 100, which still gives me a 99% chance of it not happening.

Right now, the chance of not getting measles in America, is about 99.9999777%, not bad!

And, your odds are even better if you are immunized!

How to Prevent Getting Measles

Easy- get the MMR, the measles-mumps-rubella, vaccine.  The measles shot only comes in this form in the United States.

If you get one MMR, you have a 95% chance of not getting measles if you are heavily exposed, for the rest of your life.

If you get two MMR's, at least a month apart, you have a 99% chance of not getting measles if you are heavily exposed, for the rest of your life.

So, if you don't want to get measles, get the measles (MMR) shot.

If you have had 2 MMR shots, you have essentially nothing to worry about.

What if I am exposed?

If you have had 2 MMR shots, you have essentially nothing to worry about.

If you have had no MMR shots, you can get one within 72 hours of exposure and still be protected.

What precautions should I take with my child?

The most important and the only effective precaution to take is to have your child immunized with MMR starting at age 12 months old.  (See below for a comment on infants).

Many people are starting to get a little itch of worry, maybe even a little panic.  We would say that is not helpful.

The worry is that certain places are dangerous to go to, places like birthday parties, day care centers, even doctor offices.  The worry is that kids whose families have opted not to immunize their children have children who might be very likely to come down with measles, and then transmit it to their immunized children.  This fear has led to some rather unpleasant behaviors, like marking families who are not immunizing for stigmatizing actions, like barring their children from birthday parties, etc.

Here is why this makes no sense.   Over 15% of all the people who have come down with measles in this current outbreak, were immunized.  That means that the person we fear who may expose our child to measles could very easily be someone who was immunized.  Therefore, isolating your children from unimmunized children won't work.

Now, many might say, "Dr Lavin, you just said the chance of getting measles if you are immunized is very, very tiny, how could over 15% of the people with measles be immunized?"  The answer is very simple, if you take a 0.00001% chance or even less, which all would agree is a very remote possibility, and multiply it by the total number of Americans, about 300 million, you get a hundred or so people with measles, just what we have.  And about 16% of them were fully immunized.

That is why we at Advanced Pediatrics will conduct business as usual, and resist the temptation to react to a sense of worry, and strive to stick to the facts.  Since one can get measles in this outbreak from fully immunized people, there is no protection to be had from setting up special waiting areas for people with varying immunization status.

However, if anyone does come to our office with a fever and rash that might be measles, we will isolate that person immediately and inform all in the office of the event.  

MMR is only for those 1 year and older, what is the situation with infants?

Here is some good news, all mothers give their babies protecting antibodies during pregnancy, so all babies born to mothers who are immune to measles, are immune, for roughly 6 months.   If we give a 2 month old the MMR, her mother's antibodies will clear the vaccine measles virus and no additional protection against measles will occur.

Therefore, there is no point in giving a 0-5 month old infant the MMR, it isn't necessary, and it won't work.

For babies 6-11 months old, the mother's antibody has dropped enough that they could get measles, and so an MMR is a good idea.  But since mother's antibodies are still around in this age, the MMR does not as much as it would over 1 year of age, so if a 6-11 month old infant gets an MMR, they still need 2 at 12 months old and older.

What if I actually get exposed to measles?

Let us know.  

If you have had 2 MMR's, there is not much to do, you are to likely to be fine, that doing anything at this point would not be helpful.

If you have had 1 MMR at least one month prior to the exposure, come in within 72 hours to get a second.

If you have had no MMR's at all, come in within 72 hours to get your first.

That's it.

If you are not immunized and cannot get immunized, measles tends to appear in 7-21 days after an exposure, with an average time of 14 days.  The debilitating complication of SSPE, however, which causes permanent and devastating brain damage, can take an average of 10.8 years to appear.

1.  The US is experiencing a measles epidemic.   But the chance of any one of us or our children catching it remains incredibly remote.  There are no cases reported to date in Ohio.
2.  If you or your child has had 2 MMR's- you are very well protected, even if you are exposed to q case of measles.
3.   If you are worried about you or anyone in your family getting measles, make sure everyone 1 and up has had 2 MMR's.
4.   If you get exposed you are fine if you have had 2 MMR's.  If you have only had 1, get another within 72 hours.  If you have had none, get one within 72 hours.
5.   If you get exposed and are 0-5 months old, you are fine, no need for any action to be taken.
6.   If you get exposed and are 6-11 months old, get your first MMR, but know you will still need 2 more at age 1 and up.
7.   For those who have done some research, you may come across the option of using Immune Globulin (IG).  This contains measles antibody, but is only useful for a very intense exposure for someone not previously immunized.
8.   Given that during an epidemic many of those with measles are people already immunized, there is nothing to be gained from trying to isolate the unimmunized.
9.   The only way to contain and eliminate measles cases in a community is to have the community as completely immunized as possible.
10.  For many years people feared the MMR might cause autism.  That was never a proven fear, and over the years massive proof that this was not true has come to light.  The leading US Autism Non--Profit, has come out this week urging all who can to get the MMR.   Fear of autism should not put children or others at risk for getting measles through a misguided fear of the MMR vaccine.

Perhaps the most important item to note is that the United States has experienced nearly 20 measles outbreaks since 2007, every single one ended with elimination of measles across the country, making it likely this one will too.  And why is that?  Because of the use of the MMR vaccine.

We are confident that very few, and likely nobody, in our community will get measles.   We certainly look forward to that being the case, and pleased the solution to the problem, the MMR vaccine is readily at hand.

To your health,

Dr. Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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