In 1989, I spent two months working in a hospital in Tanzania, Africa. While I worked in that small village, where no vaccines were available and care options were limited, I was shocked to discover that the main disease that killed children was measles. Not nalaria. Not malnutrition. Measles. Watching any child die of a preventable disease is heartbreaking.
Measles vaccination rates have declined, and the outbreak in the U.S. is both serious and terrifying. The likelihood of seeing it in Alaska is very high, and we need to prepare to face the consequences of this public health nightmare.
There is a great deal of controversy about vaccinations, mostly due to misinformation that started with a study in 1998 by Anthony Wakefield that postulated a connection between the measles-mumps-rubella (MMR) vaccine and autism. It has since been proven both falsified and inaccurate. There have been many studies since then that disprove that link. But misinformation is rampant, and this causes people to make unfortunate decisions — decisions that will cause deaths in our community.
Here are the facts: getting two doses of measles vaccination confers 97% immunity. Any adult born before 1957 is considered immune. If there is no laboratory evidence of immunity in adults, a booster should be given.
Children should routinely be vaccinated with the MMR initially at 12 to 15 months of age, with a second between age 4 and 6.
There are different Centers for Disease Control recommendations for travel, and for any outbreak, with infants being vaccinated earlier, and adults receiving boosters.
Measles is one of the most infectious viruses known. With exposure, nine out of 10 unimmunized people will contract the disease, by way of droplet contact. The virus remains infectious for two hours after a person is in an area. That means that if you enter an elevator two2 hours after someone with measles sneezed in that elevator, you can get the disease.
Measles starts with a high fever (as high as 105 degrees), then feeling sick, coughing, having a runny nose and getting red eyes. After that there are spots that occur in the mouth, and then a rash, which comes on about 14 days after exposure. It is a spotty rash, and it spreads from the head to the trunk, then to the lower extremities. A person is infectious for the four days before the rash starts. There are rare cases in which the rash does not appear.
The people who are most at risk for complications are children under age 5, adults over age 20 and pregnant women. There is no effective treatment, but getting immunoglobulin infusions can decrease the complication and death rate. If exposed, vaccination as soon as possible can decrease your risks, preferably within 3 days of exposure.
There is one other little known aspect to measles infection: there has been shown that a measles infection changes your prior ability to fight infection for up to three years. That means that the immunity that you have built up from prior exposures or immunizations is no longer present. It is a side effect that is only seen with measles.
My hope is that we move towards better immunization coverage to protect our community. More reliable information on Measles is available on the CDC website. You can look into this in any of the medical clinics in town, and at the public health department. If we can keep one person from getting sick from this, it will be worthwhile. If we can keep one person from dying, that will be a victory.
Giulia Tortora is a family physician who has been working in the Homer community for 25 years.