I admit that depending upon the type of clinic session I have been scheduled and whether or not a sliver of patience is left in my body at that particular moment, there are days when I want to stand on top of a chair and scream to the top of my lungs: “Immunizations Do Not Cause Autism!” Nevertheless, I refrain from such unbefitting behavior and simply do my job of providing the most up-to-date information so that my patients can make informed decisions regarding their health and that of their loved ones.
My latest rant is due to an unforeseen hiccup in an upcoming trip to California that has been marred by the measles ripple effect spreading across the country and the world which began in Disneyland back in December. Sources are not clear as to where the initial case can be traced but the majority of those cases were in unvaccinated individuals. It is likely that an international traveler may have been involved. I guess those families who chose not to immunize their children did not consider how a simple amusement park visit could result in so much turmoil.
There are parts of California where 20 percent of the population is unvaccinated and with measles being so highly contagious, rapid spread is easily accomplished. Per the CDC, Centers for Disease Control and Prevention, “measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune, will get it.” Measles is spread via coughing and sneezing but additionally can be found on surfaces and in the airspace up to 2 hours after someone has sneezed or coughed. The virus can be spread four days prior to the rash appearing and 4 days after.
One of the first written accounts of the disease was published in the 9th Century by a Persian doctor. United States healthcare providers and laboratories were required to begin reporting all known cases of measles in 1912. During that first ten years of documentation, there were 6000 deaths attributable to measles. Prior to the vaccine becoming available in the sixties, nearly all children before the age of 15 got measles. I can recall having measles as a child during the 70s and how miserable I was convalescing at home. I doubt if my parents were as vigilant as I am now with my children regarding the immunization schedule.
Symptoms of measles usually begin seven to 14 days after a person is infected. Initial symptoms are runny nose, cough, high fever, and red, watery eyes. White spots called Koplik spots begin in the mouth two or three days after the initial symptoms. The classic red rash starts three to five days after symptoms begin. The rash starts to resolve after a few days.
Though the single vaccine was effective, researchers believed that better coverage could be achieved. As a result, a second dose was recommended in 1989. The vaccine is a combination of measles, mumps, and rubella (MMR). It is recommended that children receive the first dose between the ages of 12-15 months and the second one between the ages of 4-6. Adults who do not show immunity should also be vaccinated. There has been a 99 percent reduction in measles as compared to the pre-vaccine days. At one point, measles was declared eradicated in the US but unfortunately has now been on the rise.
Measles continues to be a major problem in other nations. Twenty million people worldwide get measles and over a 120,000 people die each year from the disease. In the US from 2000 to 2013 anywhere from 37 to 220 cases were reported and those cases were believed to have originated outside of the US.
Physicians are encouraged to continue to educate patients and their families on the importance of getting vaccinated against measles. There is no literature linking immunizations with autism yet that belief continues to circulate within the community. Some providers are choosing not to care for children whose families refuse to vaccinate. I disagree with such extreme practices because we as clinicians cannot blame the innocent kids in this debate. I believe our job is to persevere with our education thereby helping the parent make the appropriate decision for their child.
My best advice for now during this current outbreak is to consider measles as a possible diagnosis if you or a child has a high fever, runny nose and rash. Possible measles complications include encephalitis (brain infection) and respiratory problems. People with weakened immune systems and pregnant people are at greatest risk. I also advise everyone to read credible sources such as the CDC or the NIH websites regarding vaccine safety. Not immunizing your child is not only a risk to your child but to others as well.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
